# Sternocleidomastoid Muscle Flap in an Older Patient With Congenital Muscular Torticollis

## TL;DR

A 64-year-old woman with long-standing congenital muscular torticollis showed improvement after surgery using a sternocleidomastoid muscle flap.

## Contribution

Demonstrates successful use of SCMM flap for CMT in older patients and its effectiveness in reconstructing parotid defects.

## Key findings

- SCMM flap transfer improved torticollis and cheek depression in a 64-year-old patient.
- Indocyanine green fluorescence angiography safely guided SCMM flap elevation.
- Surgical treatment for neglected CMT in older patients is effective.

## Abstract

Congenital muscular torticollis (CMT) is caused by muscle damage during childbirth, tumors, or masses within the muscles and generally resolves with physical therapy during infancy. In this study, we performed reconstruction after resection of a parotid gland tumor using a sternocleidomastoid muscle (SCMM) flap in an older patient with neglected CMT. The patient was a 64-year-old woman who had had a left-sided oblique neck since infancy but had never received any treatment, including physical therapy. She underwent parotid tumor resection and SCMM flap transfer. The SCMM flap can be safely elevated using indocyanine green fluorescence angiography, with the middle pedicle serving as the feeding vessel to fill the parotid defect. Three months after surgery, the torticollis had improved and the cheek depression was not noticeable, indicating the effectiveness of surgical treatment for CMT in older patients and the possibility of using SCMM as a muscle flap.