FRONTAL CEPHALOMETRIC ANALYSIS IN THE EVALUATION OF FACIAL ASYMMETRY AND RESULTS OF BIPOLAR RELEASE IN PATIENTS TREATED OVER 6 YEARS OF AGE IN TORTICOLLIS

Abstract

Purpose: To investigate the mid-term results of patient with congenital muscular torticollis treated over 6 years of age by bipolar release, and the use of frontal cephalometric analysis in the determination and follow-up of facial asymmetry.
Patients and methods: Twelve patients (9 boys, 3 girls) whose ages ranged from 7 to 12 years of age were included in the study. Bipolar release was performed, followed by 5-7 days of traction and 3 months of physiotherapy. Posteroanterior cephalometric radiography was performed at the beginning and after therapy. Postural symmetry angle (PSA) was used to determine the presence and severity of facial asymmetry. A modified version of Lee et al.’s system was used for evaluating the results.
Results: The average follow-up period was 3 years and 5 months. According to the congenital muscular torticollis evaluation system, the outcome was excellent in 2 of the patients, good in 6, inadequate in 2 and poor in 2. Asymmetry was not severe in all patients at the beginning of therapy according to PSA values, being insignificant in two, moderate in 6, and severe in 4. The PSA results of the latest examination revealed that severe facial asymmetry persisted in 3 patients. In 2 of these, PSA values remained within the limits of severe asymmetry despite a slight angular correction.
Conclusion: Congenital muscular torticollis patients can benefit from surgical intervention above the age of 6. Bipolar release is an adequate and complication-free method. Moreover, PSA may be used as an objective method in the determination and follow-up of facial asymmetry in patients with torticollis.