PMC4738269_01
Images of tethering and anterior SCM defect pre-operatively and post-operative resolution of marked tethering and appearance of incision. Noticeable tethering from the lateral view marked with an arrow (A) and from the anterior view with previous stair-step incision marked in red (B). Lateral view of pre-operative planning for Z-plasty incision with Langer lines indicated in blue (C). Two views of post-operative decrease in tethering (D,F). Post-operative appearance of Z-plasty incision at 6 months (E).
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F1
Additionally on physical exam, a localized band of tissue with tethering could be palpated within the superior portion of the remaining SCM with rotation to the left, a taut right SCM can be seen along the entire remnant of the muscle (Figure 1).
MRI of fibrotic band and remnant SCM. Sequential coronal (A,B) and axial (C,D) images of the fibrotic band (solid arrow) on coronal sequences, remnant SCM (solid arrow) on axial images and the carotid artery (red asterisk), internal jugular vein (blue asterisk), and left SCM (dashed arrow) are indicated for reference.
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F2
MRI prior to the second operative intervention showed marked atrophy of the right SCM and a persistent fibrotic band just deep to the skin (Figure 2).
Intraoperative images and fibrotic band. Initial dissection with isolation and neurolysis of the great auricular nerve indicated by the black suture (A). Right sternocleidomastoid (SCM) indicated by the forceps (B). Fibrotic band within the SCM (C). Closure of Z-plasty incision (D) after resection of fibrotic band and remnant SCM (E).
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F3
This was done by performing a Z-plasty incision joining the previous two superior incisions, followed by neurolysis of the great auricular nerve and circumferential release of the area causing the tethering (Figure 3). During the operation, a 3.5-cm section of fibrotic tissue was completely resected along with the remnant posterior belly of the SCM, revealing benign fibroadipose tissue, fibrotic skeletal muscle, and nerve with focal atrophic and reactive changes (Figure 3B).