腔镜下腋、颈部入路胸锁乳突肌松解术矫正先天性肌性斜颈

Objective A transaxillary and transcervical endoscopy technique was developed for the release of the sternocleidomastoid muscle in congenital muscular torticollis. The efficacy of the op-eration was evaluated. Methods A total of 34 children with congenital torticollis were treated. The age ranged from 6 month to 14 years. A 5 nun trocar was inserted in the anterior axillary fold. A subcuta-neous tunnel perpendicular to the axis of the sternocleidomastoid was made, initially under direct vision and then endoscopically using a 5 mm endoscope. A subcutaneous space was established with CO2 in-flation at the pressure of 6 mm Hg. Another two 1.5～2 mm incisions were made besides sternocleido-mastoid for the introduction of mini forceps and electric knife, respectively. The sternocleidomastoid muscle and scalene were dissected out and divided with electrocautery. Lee's evaluation was carried out post-operatively. Results The operation was successfully completed under endoscope in all children. The mean operation time was 50 min ( range: 40～120 min). No injury of major nerve was encoun-tercel Haemorrage in one child required re-operation. Follow-up for 6 months to 3 years showed satis-factory cosmetic appearance and no recurrence. The results were classified as excellent in 88.2 %, good in 8.8%,and fair in 3.0%. The neck scars were not visible one month after surgery. Conclusions Transaxillary and transcervical endoscopic release of congenital torticollis is a safe and relatively quick procedure. It provides good access and good cosmetic outcomes. It avoids injury to neurovascular struc-tures.

Endoscopic release of tortieollis