Improvement of Congenital Muscular Torticollis with Mild Symptoms in Non-Treated Adult after Simple Surgical Myotomy of Sternocleidomastoid Muscle under Local Anesthesia

In adult congenital muscular torticollis (CMT) patients, physical therapy is not as effective because the development of sternocleidomastoid muscle (SCM) muscle is complete. While surgical release can address CMT in adult patients, the risk of general anesthesia and visible postoperative scar is a concern, expecially in patients with mild symptoms. In this paper, we report our experience in treating such patients with minimal-incision myotomy under local anesthesia. A review was performed for all adult patients who had undergone the simple myotomy procedure. Surgical indication was reserved for patients with mild fibrotic band in the SCM muscle with minimal lengthdiscrepancybetween the muscles. All patients had recognizable head tiltand palpation of fibrotic band on affected side of the neck. Surgical details are described in the main body of text. Three female patients had undergone the procedure. Torticollis was resolve in all patients with complete restoration of ranage of motion. There were no postoperative complications, and patient satisfaction was high. We have reported three cases of mild CMT in adult female patients, who had undergone minimal-incision myotomy under local anesthesia. Outcomes were satisafactory with no morbidity to report. With careful patient selection, this method offers an alternate treatment option for adult CMT patients with mild symptoms.

Review of Keloid Patients with Clinical Experience

BACKGROUND: Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood. Despite many studies of the pathogenesis and cause, little is known of the predisposing factors or the diathesis. Therefore, we evaluated patients with keloid for 13 years clinical experience, with the goal of considering the causative factors and physical disposition of keloid. METHODS: We evaluated 107 patients (38 males, 69 females; median age 22.31 years, range 7-58 years) who visited the department of plastic and reconstructive surgery from March 1998 to December 2010. The patients' chart and clinical photo were reviewed for the study. RESULTS: Etiologies were an intended wound like piercing or surgical wound (n=39), avulsion flap injury (n=30), laceration (n=29) and burn (n=9). The location were the head and neck (n=38), trunk (n=23), upper extremity (n=21), lower extremity (n=16) and face (n=9). Patients with more than overweight (>23 kg/m2, Body mass index) were 84 in 107 patients (78.5%) with keloids. CONCLUSIONS: In the care of the keloids, patient information, particularly sex, age and body mass index, it may be useful indicators for expecting prognosis of the patients and treating with proper management. Particularly, large-scale accurate follow-up observations on obese patients will be critical.