Objective: Congenital midline cervical cleft (MCC) is a rare malformation. The typical case shows an area of hypotrophic skin, a cranial nipple-like structure and a caudal blind sinus. Neck extension is limited. Relapse of cervical retraction is common following removal of the cutaneous lesion and z-plasty.
Aim: to communicate the finding of a contractile structure responsible of neck retraction, not previously described.
Design: a descriptive retrospective study about patients with MCC treated in our center in the last 8 years.
Setting: description of cases treated in our public tertiary pediatric hospital.
Patients: four cases.
Interventions: The radiological, surgical and histological findings of the cases.
Main outcome: the presence of a muscular band could be the responsible of neck retraction and relapse of this pathology. Hypothesis was formulated during data collection.
Results: A longitudinal, contractile band was found immediately below the skin at the reoperation of case 1 for relapsed neck retraction three years after the first procedure. The specimen contained striated muscle. In cases 2 and 4 MRI evidenced a subcutaneous muscular structure. In all four children a longitudinal muscular band was found immediately underlying the skin and removed. The finding was confirmed in the three cases in which a pathology exam was available.
Conclusions: A distinct anatomical muscular band, anterior to the platysma, is responsible for limitation to neck extension. Removal of this structure releases tension from the neck; therefore, neck z-plasty could be unnecessary.
Key words: Midline cervical cleft, Neck lesions, Congenital, Neck surgery, Reconstructive surgery.