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| CASE REPORT |
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| Year : 2022 | Volume
: 24
| Issue : 4 | Page : 185-187 |
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Sternocleidomastoid tumor in an older child
Agnik Saha1, Anwesha Mondal2, Rajib Sikder3, Pankaj Halder4
1 Department of General Surgery, R. G. Kar Medical College, Kolkata, West Bengal, India
2 Department of Pediatric Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India
3 Department of Anesthesiology, R. G. Kar Medical College, Kolkata, West Bengal, India
4 Department of Pediatric Surgery, R. G. Kar Medical College, Kolkata, West Bengal, India
| Date of Submission | 09-Sep-2022 |
| Date of Decision | 16-Oct-2022 |
| Date of Acceptance | 20-Oct-2022 |
| Date of Web Publication | 30-Dec-2022 |
Correspondence Address:
Dr. Pankaj Halder
Saroda Palli, Sitko Road, Baruipur, Kolkata - 700 144, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/sjoh.sjoh_42_22
In newborns and infants with congenital space-occupying cervical lesions, sternocleidomastoid tumors represent a relatively uncommon differential diagnosis. With an early and prolonged manual stretching exercise, it does generally go away. Some may need to have the muscle surgically released to avoid plagiocephaly, facial asymmetry, and scoliosis. We report a case of a 6-year-old child with significant torticollis who required surgery for a favorable cosmetic and functional outcome.
Keywords: Conservative, physiotherapy, sternocleidomastoid, surgery, torticollis, tumor
How to cite this article:
Saha A, Mondal A, Sikder R, Halder P. Sternocleidomastoid tumor in an older child. Saudi J Otorhinolaryngol Head Neck Surg 2022;24:185-7 |
How to cite this URL:
Saha A, Mondal A, Sikder R, Halder P. Sternocleidomastoid tumor in an older child. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2022 [cited 2023 Jan 30];24:185-7. Available from: https://www.sjohns.org/text.asp?2022/24/4/185/366334 |
| Introduction | |  |
A sternocleidomastoid (SCM) tumor is a thickening of the SCM muscle that causes torticollis and neck mass in newborns and young children. Although bilateral cases have been documented in the literature, it is mostly unilateral. The incidence ranges from 0.4% to 1.3% of live births. Although the specific etiology is uncertain, it is assumed that trauma/stretching or ischemia of muscle following a difficult or forceps delivery is significant.[1] Treatment consists of assurance of parents and conservative therapy in the form of gentle manual stretching program. Surgery (surgical release of the SCM muscle) is only occasionally (6.7%) necessary in unresolved cases. Moreover, to achieve a good outcome, intense physiotherapy is essential in the immediate postoperative period for a considerable amount of time. We describe the case of a 6-year-old child with an SCM tumor, who required bilateral surgical release of the SCM to avoid severe torticollis and its associated consequences.
| Case Report | | |
A 6-year-old boy was admitted with a right-sided neck mass and severe torticollis [Figure 1]. The mother observed a rightward head tilt as a preference. He was an otherwise healthy child who had a history of instrumental delivery. Family history was irrelevant. There was no prior history of fever, trauma to the neck, or respiratory problems. On examination, the neck swelling was firm, of average size, partially mobile, not warm on touch, and apparently painless, attached to the right SCM muscle. There were restricted neck movements, no cervical lymphadenopathy, no signs of infiltration or other anomalies were found. Both clinical and radiological findings favored the diagnosis of SCM tumor. An hypoechogenic, homogenous, and fusiform mass of SCM muscle was identified by neck Ultrasonograpgy (USG). According to the mother, despite routine stretching and physiotherapy, the mass did not go away, and the severity of the torticollis worsened. A psycho-social inhibition and a lack of enthusiasm in attending social events and school were formed in the child. He also continued to stare while adjusting his eye movement (squint). We made the decision to move through with the surgical release of the right SCM muscle after speaking with the plastic surgeon at our institute. Under general anesthesia with endotracheal intubation, the child is positioned in the supine posture with his neck slightly extended. Then, the sternum, clavicle, and mastoid ends of the right SCM muscle were all freed [Figure 2]. There were no issues during the postoperative period. The young patient was requested to visit the postoperative follow-up clinic to receive detailed scheduled physiotherapy and to assist in learning how to use a torticollis brace. The child achieves a favorable cosmetic outlook and loses psychosocial inhibition after a year of routine follow-up [Figure 3]. | Figure 1: Clinical picture of 6-year-old male child shows right-sided neck mass and severe torticollis
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 | Figure 2: Intraoperative pictures show bipolar transection of the right sternocleidomastoid muscle from its both ends
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 | Figure 3: Postoperative pictures of the child show the evidence of improvement and cosmetic outlook
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| Discussion | | |
The benign SCM tumor, also known as fibromatosis colli, typically manifests in newborns as torticollis. It is a self-limiting fibroblastic tumor that typically develops on the left side and primarily affects male child.[2] Most afflicted infants are identified before they turn 6 months old (most common between 2 and 4 weeks of age).
Various theories have been proposed which include fetal malposition, birth trauma, ischemic necrosis following vascular compression during birth, infection, and presence of endogenous factor. The most popular view is that birth trauma is related to challenging or aided deliveries, such as forceps deliveries.[3] It could be linked to other birth malformations like club feet or congenital hip dislocations, among others. There was a history of instrumental delivery in this case; however, no other congenital defects were seen.
The USG remains the first chosen investigation, because of its accessibility, cheap cost, noninvasiveness, and 100% sensitivity. This real-time sonography can be used to demonstrate how the lesion moves in synchrony with the affected muscle.[4] When both the USG and the clinical findings are inconsistent with the diagnosis, a computed tomography or magnetic resonance imaging scan is required. In addition, they aid in the differentiation of other lesions such as lymphoma, branchial cysts, thyroglossal cysts, hemangiomas, cystic hygromas, rhabdomyosarcoma, and neuroblastomas.[5] In order to prevent unnecessary delays in the identification and treatment of a rather uncommon neck lesion, Wani et al. recommended that fine-needle aspiration cytology be taken into consideration. It is simple, cost-effective, available even in remote areas and can quickly confirm the presence of SCM tumors.[6]
Torticollis typically resolves on its own (80%–90%) within the 1st year of life. The primary mode of treatment is conservative, involving early initiation of passive or active physiotherapy and periodic evaluations every 2 to 4 weeks. The patient's head must be held in a position that stretches the affected muscle.[7] Torticollis may continue after the age of 1 year in roughly 10% of cases. In those who have advanced torticollis beyond the age of 1 year, late diagnosis (after the age of one), or craniofacial problems, surgical intervention is advised.[8] The facial asymmetry in our child appeared when he was 6 years old, which was too late to begin conservative treatment. According to Bhuyan et al., with the right surgery and rehabilitation (usage of a torticollis brace postoperatively), older (delayed presentation) patients can achieve positive results.[9]
| Conclusion | | |
Conventionally, conservative therapy is effective in treating the SCM tumor. In neglected and older children with severe skeletal and facial abnormalities, surgical relaxation of the SCM muscle should be taken into consideration. Patients who present late can still have successful outcomes if the optimum surgery and physiotherapy (rehabilitation) are performed.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Gjeta I, Sala D, Bakalli I, Ҫelaj E, Hoxha V, Biqiku M, et al. Clinical and diagnostic approach to a pediatric patient presented with a lateral neck mass. World J Med Case Rep 2022;3:8-10. |
| 3. | Khan S, Jetley S, Jairajpuri Z, Husain M. Fibromatosis colli – A rare cytological diagnosis in infantile neck swellings. J Clin Diagn Res 2014;8:D08-9. |
| 4. | Bouraoui IH, Arifa N, Gaha M, Kermani W, Dali KM, Jemni H, et al. Sternocleidomastoid pseudotumor of infancy: A report of thirteen cases. JBR-BTR 2012;95:6-9. |
| 5. | Oliveira JC, Abreu MS, Gomes FM. Sternocleidomastoid tumor in neonate: Fibromatosis colli. BMJ Case Rep 2018;2018:bcr2017223543. |
| 6. | Wani R, Ahmad M, Bhat S, Sheikh S. Sternocleidomastoid pseudotumor: A prompt fine-needle aspiration cytology diagnosis. J Clin Neonatol 2018;7:105-7. [Full text] |
| 7. | Goel S, Jain N, Narang E, Roy S. Bilateral sternocleidomastoid tumor of infancy: A rare diagnostic dilemma. Int J Otorhinolaryngol Head Neck Surg 2020;6:1377-9. |
| 8. | Pal K, Bhat N, Moghazy K, Mitra DK, Hegazi M. Diffuse idiopathic hyperplasia of the sternocleidomastoid muscle in a child. Ann Saudi Med 2009;29:471-3. [ PUBMED] [Full text] |
| 9. | Bhuyan BK. Outcome of bipolar release of the sternocleidomastoid muscle in neglected congenital muscular torticollis. Med J DY Patil Univ 2014;7:584-8. [Full text] |
[Figure 1], [Figure 2], [Figure 3]
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