21720 Division of sternocleidomastoid for torticollis, open operation; without cast application

Name of the Procedure:

Division of Sternocleidomastoid for Torticollis, Open Operation; Without Cast Application

Summary

This surgery involves making an incision in the neck to partially cut the sternocleidomastoid muscle, which is causing abnormal head tilt (torticollis). This procedure helps to correct the head position by releasing the muscle tension.

Purpose

• Medical Condition: Congenital muscular torticollis (CMT) or acquired torticollis.
• Goals: To correct the abnormal head position, alleviate pain, and improve range of motion. The procedure aims to enhance the patient's appearance and function.

Indications

• Persistent tilt of the head to one side, with a noticeable tight or shortened sternocleidomastoid muscle.
• Patients who have not responded to physical therapy or other non-surgical treatments.
• Infants, children, or adults with functional or cosmetic concerns due to torticollis.

Preparation

• Pre-procedure Instructions: Fasting for 6-12 hours prior to surgery if general anesthesia is used. Avoiding certain medications as advised by the doctor.
• Diagnostic Tests: Physical examination, imaging studies (such as X-rays or ultrasound), and possible pre-operative blood tests.

Procedure Description

1. Anesthesia: Administered general anesthesia to ensure the patient is asleep and pain-free.
2. Incision: A small incision is made along a natural skin crease in the neck to minimize scarring.
3. Muscle Division: The sternocleidomastoid muscle is carefully exposed and partially divided to release the tension.
4. Closure: The incision is closed with sutures, and a sterile dressing is applied.
   • Tools and Equipment: Scalpel, retractors, surgical scissors, sutures, and sterile dressings.

Duration

The procedure typically lasts between 30 minutes to 1 hour.

Setting

Performed in a hospital’s operating room or a specialized surgical center.

Personnel

• Surgeon: A specialist in pediatric or orthopedic surgery.
• Nurses: Surgical nurses to assist the surgeon and monitor the patient.
• Anesthesiologist: To manage anesthesia and patient safety.

Risks and Complications

• Common Risks: Bleeding, infection, and scarring.
• Rare Risks: Nerve injury, recurrence of torticollis, and anesthesia-related complications.

Benefits

• Expected Benefits: Immediate improvement in head posture. Reduced pain and increased range of motion.
• Realization: Benefits are often noticed shortly after recovery from surgery, as the muscle tissue heals and adjusts.

Recovery

• Post-procedure Care: Pain management with prescribed medications, keeping the surgical site clean and dry.
• Recovery Time: Typically, several weeks to fully return to normal activities. Physical therapy may be recommended to aid recovery.
• Follow-up: Post-operative appointments to monitor healing and progress.

Alternatives

• Non-surgical Options: Physical therapy, stretching exercises, and use of neck braces.
• Pros and Cons: Non-surgical methods are less invasive but may not be effective for all patients. Surgery provides a more definitive correction but comes with surgical risks.

Patient Experience

• During the Procedure: The patient will be asleep under general anesthesia and won’t feel anything.
• After the Procedure: Mild discomfort or pain managed with medication. Possible neck stiffness, which improves with time.
• Pain Management: Prescribed pain relievers and comfort measures, such as applying ice to reduce swelling.