Clinical factors in patients with congenital muscular torticollis treated with surgical resection.

BACKGROUND: Congenital muscular torticollis (CMT) is characterized by persistent head tilt toward the affected side. No consensus exists regarding the cause of this disorder. In this study, we analyzed various clinical factors in patients with CMT who were treated with surgical release. This analysis enabled us to identify potential causative factors of CMT and to establish a basis for surgical interventions. METHODS: In total, 584 patients who underwent surgical intervention for CMT from October 2007 to December 2016 were included in this study. Their demographic characteristics, birthrelated factors, and clinical features were analyzed. RESULTS: Data from 525 patients were analyzed in this study after exclusion of those with insufficient information. Before birth, 31 patients (5.9%) were diagnosed with oligohydramnios, and 87 (16.6%) had a breech presentation. Seven (1.3%) cases of clavicle fracture and two (0.4%) cases of cephalohematoma were noted at birth. Before surgery, 397 patients (75.6%) underwent physiotherapy and 128 patients (24.4%) did not. The duration of physiotherapy ranged from 1 to 50 months (average, 6 months). CONCLUSIONS: Our study shows that 16.6% of the CMT patients presented in the breech position, which is a much higher rate than that observed in the general population (3%-4%). We hypothesize that being in the breech position as a fetus appears to exert a significant influence on shortening and fibrosis of the sternocleidomastoid muscle.

Analysis of Facial Injuries in Motor Vehicle Accidents According to the Location of the Seat and Seat-Belt Use.

The purpose of this study was to evaluate facial trauma in accidents involving a passenger car. In particular, the authors assessed differences in types of facial trauma and severity according to the location of the seat and seat-belt use. A 7-year retrospective review of data was conducted for 419 patients with facial trauma resulting from motor vehicle accidents. Patients who used a seat belt faced a lower risk of severe soft-tissue injury in comparison with having mild soft-tissue injury than patients who did not use a seat belt (P = 0.0129). Additionally, patients who used a seat belt had a lower risk of accompanying facial bone fracture requiring surgical operation than patients who did not use a seat belt (P = 0.0168). In terms of facial bone fracture according to seat location, patients who had sat in the back seat had more risk of accompanying facial bone fracture than patients who had sat in the passenger's seat (P = 0.0392). In terms of facial bone fractures requiring surgical operation, the patients who had sat in a back seat faced more risk of needing a surgical operation than patients who had sat in the driver's seat (P = 0.0479). The results of the study reveal that wearing a seat belt effectively reduces severe facial soft-tissue injury and facial bone fracture requiring surgical operation. In particular, the authors note that sitting in a back seat is riskier in terms of facial bone injury than sitting in a front seat.

Primary Merkel cell carcinoma of the earlobe in a young healthy man.

Merkel cell carcinoma (MCC) is an uncommon neuroendocrine cutaneous tumor with poor prognosis. It has the high rate of recurrence, mortality, regional nodal involvement, and distant metastases. It is difficult to diagnose MCC because of its non-specific clinical findings. It usually occurs on sun-exposed areas of the skin, mostly at head and neck. There is a difference in the incidence and prognosis according to site in the head and neck. However, there is no consented site-specific diagnosis, treatment or follow-up protocol for MCC at the head and neck. We herein report a case of MCC arising in the right earlobe of an otherwise healthy young man who has been diagnosed early, thereby successfully treated. With our closed follow-up, there was no tumor recurrence or complication at 33 months after diagnosis.

Solitary mastocytoma presenting at birth.

Mastocytosis is a rare disease which occurs in both children and adults, and it can manifest as a solitary or multiple skin lesions. Both can cause cutaneous or systemic symptoms. Because of the heterogeneity of clinical presentation of mastocytosis and its rare prevalence, it can be hard to suspect the mastocytosis at the first time. Most solitary mastocytomas are about 1-5 cm in diameter and have features of brownish-yellow, minimally elevated plaques with a smooth shiny surface. This article presents a case of solitary mastocytoma which occurred in neonate and that we treated through surgical excision. In histopathological examination, it consisted of c-kit-positive mast cells. Although pediatric cutaneous mastocytosis might regress spontaneously, clinicians should keep in mind that it could be associated with systemic mastocytosis which involves hematopoietic system.