The practice of surgery . spasm of muscles, throwing the head to one side in a painful,distressing, and somewhat ludicrous fashion. The muscles generallyaffected are the sternomastoid and trapezius, more rarely the spleniuscapitis, the complexus, the trachelomastoid, and the inferior G. L. Walton, Amer. Jour. Med. Sci., March, 1898. 588 THE FACE AND NECK In most cases the spasm attacks the sternomastoid of one side and theposterior rotators of the other, so that these two grou])s of musclescombine to rotate the oc(ij)ut and give the chin an u])\vard tih. Karelyboth sternomastoids alo
The practice of surgery . spasm of muscles, throwing the head to one side in a painful,distressing, and somewhat ludicrous fashion. The muscles generallyaffected are the sternomastoid and trapezius, more rarely the spleniuscapitis, the complexus, the trachelomastoid, and the inferior G. L. Walton, Amer. Jour. Med. Sci., March, 1898. 588 THE FACE AND NECK In most cases the spasm attacks the sternomastoid of one side and theposterior rotators of the other, so that these two grou])s of musclescombine to rotate the oc(ij)ut and give the chin an u])\vard tih. Karelyboth sternomastoids alone are affected, or, still more rarely, the pos-terior rotators of both sides. You can do little for these cases Avith drugs, electricity, massage,and similar remedies, though occasionally a confining collar will givethe patient the desired comfort. Nor are operations altogether satis-factory, and such operations as we can do vary greatly in their severityfrom simple nerve-stretching to extensive tenotomies. If an opera-. Fig. 388.—Spasmodic torticollis (Massachusetts General Hospital). tion be undertaken, therefore, it is good practice to resect first thespinal accessory nerve on the affected side, in the hope that this willrelieve the symptoms. Should this operation fail, the surgeon may pro-ceed to the more radical division and avulsion of the posterior branchesof the three first spinal nerves on the opposite side (Keen); or even totenotomies of all the muscles affected (Kocher). After the operationthe patients head should be supported for at least three weeks in a well-fitting Thomas collar, and the surgeon must attend specially to thepatients general condition, directing careful massage, suitable tonics,an out-of-doors rest-cure, or a long vacation. Persistence in these CERVICAL ADENITIS 589 measures will often relieve completely the sufferer; and the destructionof nerves and muscles, even, may be so far recovered from as to leavethe patient with a useful and sightly nec
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