Clinical Outcome in the Surgical Intervention of Congenital Muscular Torticollis

Abstract

A number of studies have shown that facial asymmetry improves in congenital muscular torticollis (CMT) patients after surgical release. This study confirmed the improvement in facial asymmetry, and analyzed factors that affect the change of facial asymmetry in CMT patients after surgical release by using objective and quantitative methods. Facial asymmetry was analyzed in 60 CMT patients who underwent surgical release before 10 years of age. Horizontal and lower facial asymmetry angles (HFAA and LFAA) in the clinical photograph were used to measure facial asymmetry. Postoperative improvements in HFAA and LFAA were evaluated in each age group, after grouping the patients by age. Patients were divided into 2 groups according to the postoperative head tilt and functional deficit. Postoperative improvements in HFAA and LFAA were compared between 2 groups. The relationships between postoperative improvements in HFAA and LFAA and independent variables (age, follow-up period, preoperative HFAA or LFAA, postoperative head tilt, and postoperative functional deficit) were analyzed. Mean age at operation was 34.8 months (range, 6-120 mo). Horizontal facial asymmetry angle was improved significantly postoperatively in groups <5 years of age. Lower facial asymmetry angle was improved significantly postoperatively in all age groups. No significant difference was found in the postoperative improvements in HFAA and LFAA between 2 groups according to the postoperative head tilt and functional deficit. In the correlation analysis, postoperative improvements in HFAA and LFAA were proportional to the follow-up period (r = 0.256, P = 0.048) and preoperative HFAA or LFAA (r = 0.600, P < 0.001). Facial asymmetry in CMT patients can be improved in part if surgical release is performed before 10 years of age and the possibility of improvement may be different according to the area of the face. After surgical release, facial asymmetry will improve over a long period of time, and patients with more severe facial asymmetry have a better remodeling potential to achieve facial symmetry.

사경 환자들의 수술적 치료 이후 안면비대칭의 호전이 보고되어 있다. 이번 연구에서는 사경 수술 결과에 대한 평가로 객관적인 계측치를 측정하고 정량적인 분석을 하여 술후 안면비대칭의 변화에 영향을 미치는 요인을 분석하였다. 10세 이전에 사경수술을 받은 60명의 환아를 대상으로 각 연령군에 대해 술전, 술후의 임상사진을 가지고 horizontal facial asymmetry angle(HFAA)와 lower facial asymmetry angle(LFAA)를 측정하였다. 또한 환자들은 술후 머리기울기와 기능적 결손을 기준으로 두 개의 군으로 나뉘어 술후 HFAA와 LFAA의 변화를 비교하였다. HFAA는 5세 이하 연령군에서 의미 있는 술후 개선효과가 나타났으며, LFAA는 모든 연령군에서 의미 있는 술후 개선효과가 나타났다. 술후 기울기와 기능적 결손에 따른 두 개의 군 사이에서 HFAA, LFAA의 술후 변화는 의미있는 차이가 없었다. 10세 이하의 사경 환자에게 수술적 치료이후 안면비대칭은 부위에 따라 다른 회복가능성이 확인되었다.