sternomastoid on one side is fibrous & fails to elongate as the child grows resulting in progressive deformity
Aetiology
Unknown
? Ischaemia
muscle may have suffered ischaemia form a distorted position in utero
supported by the association with breech presentation & DDH
? trauma
May be due to birth trauma
Epidemiology
Males > Females
Right > Left
Associations
DDH & acetabular dysplasia in 10 – 20%
may be related to intra-uterine posture with an ↑ incidence in breach deliveries & difficult labours
Anatomy
Pathology
‘Sternomastoid tumour’
In 20% a lump (sternomastoid ‘tumour’)is noticed in the first few weeks of life in the belly of the sternocleidomastoid on the side of the tilt
Usually well defined & may involve one or both heads of the sternomastoid
At this stage there is no deformity or loss of movement & deformity becomes apparent usually at 3 – 4 years of age
Shortening of the muscle results in the mastoid process approximating the sternal notch (the ear becomes lower & further forward) & the entire face is tilted down on the affected side- the face is shorter on the affected side
sternomastoid feels tight & cord like
Classification
History
Examination
Investigations
X-Rays
Normal
Performed to exclude a congenital cervical abnormality
Differential Diagnosis
Treatment
Initial
If a child has a sternomastoid tumour every effort should be made to prevent deformity developing
physiotherapy, stretching & splintage
If deformity persists
surgery at 1 – 4 years (Best time for operation is 18 months to 2 years)
subcutaneous tenotomy (distal end) with care to avoid neurovascular structures
open division of either the upper or lower end (recurrence rate following surgery less than 5%)
Operative release is indicated
if nonoperative treatment fails
if late presentation with rigid deformity
post op
correction is maintained using a splint or collar worn for several months until head is held straight
Complications
Prognosis
5% recurrence rate
correction before the age of 4 years the facial asymmetry can resolve
