Paralysis of the trapezius associated with myogenic torticollis. A report of 6 cases.

The authors report the follow-up results of forty-three patients operated on for myogenic torticollis between 1965 and 1975. The surgical treatment consisted of distal tenotomy in eight cases, distal and proximal tenotomy in twenty-three cases, tenomyomectomy in eight cases. The results were subdivided into three groups: excellent twenty-two, (57 per cent); good , fourteen (38 per cent); poor, two (five per cent). The most interesting finding that emerged was the association of paralysis of the trapezius muscle with myogenic torticollis: this was observed in six cases, three after and three before operation. Preoperative investigations, including an EMG test and confirmation at operation, appeared to show that the paralysis was secondary to compression of the accessory nerve in its passage through the sternocleidomastoid muscle. Neurolysis, performed in three cases, led to recovery of the paralysis. Compression of the accessory nerve is slowly progressive, and paralysis or paresis of the trapezius muscle therefore occurred late. In fact, the patients who presented with both lesions were well beyond infancy. The authors emphasize the importance of being aware of the association of this lesion with myogenic torticollis so that operation for the latter may complemented by neurolysis of the accessory nerve.