• Persistent muscular torticollis children

• Patients failing rehabilitation

• Patients/families concerned with neck scars

• Patients requiring immediate post-op rehab

• Failed multiple conservative treatments

• School-age children (avg 6.5 years)

Kaohsiung Medical University Hospital's Pediatric Surgery team pioneered the "Trans-axillary Subfascial Endoscopic Torticollis Surgery" in 2011. Using two 0.5cm axillary incisions, dissection beneath the pectoralis major fascia, and Harmonic scalpel to release the fibrotic sternocleidomastoid muscle band, this technique avoids platysma injury, minimizes bleeding/hematoma, eliminates drain placement, hides scars in the axilla, and allows immediate post-op rehabilitation. A 13-year retrospective study (Pediatr Neonatol 2024) demonstrated zero recurrence with 90.9% Excellent/Good outcomes and preservation of neck contour. Cumulative 33 children (46 procedures): average age 6.5, operation time 90 min, LOS 2.49 days, follow-up 15 months. No comparable Taiwan publications. Surpasses Stanford, Atlanta, and three Chinese centers in scar concealment, rehab timeline, and complications.

• Taiwan-first trans-axillary subfascial endoscopic surgery

• Two 0.5 cm axillary incisions, no neck scar

• Harmonic scalpel minimizes bleeding, no drains

• Subfascial dissection preserves contour

• Immediate post-op rehabilitation

• SDM evaluation tools provided

• Cumulative 33 children (46 procedures)

• Average age: 6.5 years

• Average operation time: 90 min

• Average LOS: 2.49 days

• Average follow-up: 15 months

• No comparable surgery at other Taiwan centers

• Excellent/Good outcome rate: 90.9%

• Recurrence rate: 0%

• Outcome independent of gender, age, side

• Operation time correlated with weight (r=0.618)

• Better than neck-incision surgery (88%)

• Comparable to Chinese pre-chest approach (88-97%)

• 0% recurrence rate

• No nerve injury

• No seroma or hematoma

• No drain placement

• No serious complications reported

• Avoids difficulty of retroauricular approach

• No neck incision, high cosmetic satisfaction

• Preserves neck contour

• Immediate rehab possible

• Positive family long-term feedback

• Featured twice in KMUH monthly

• Facebook page case sharing

• Pediatr Neonatol 2024: 13-year retrospective study

• Surg Laparosc Endosc Percutan Tech 2011 inaugural paper

• Cited in international PubMed publications

• Outperforms US, China, Japan, Korea benchmarks

• Only domestic publication, leading in Taiwan

• Leads international torticollis endoscopic surgery

• Establishes international standard endoscopic torticollis surgery

• Replaces traditional neck incision, reduces scarring

• Promotes SDM model in pediatric surgery

• Raises Taiwan pediatric surgery international visibility

• Provides optimal treatment for pediatric torticollis