Birth injury to the sternomastoid muscle.

two most popular. The theory of birth injury has been a matter of controversy since it was first postulated by Stromeyer in I 838. Stromeyer believed that the sternomastoid was ruptured during labour, giving rise to the “ sternomastoid tumour,” which he felt was in reality a haematoma, leading to myositis with replacement by fibrous tissue. Stromeyer’s theory has been supported, fully or in part, by many subsequent writers (Spencer 1893, Bevan 1918, Meyerding 1921, Chandler and Altenberg 1944), but others have dismissed trauma and haematoma as possible causes of “ sternomastoid tumour “ and torticollis (Witzel 1883, Nov#{233}-Josserand and Viannay 1906, FitzSimmons 1933, Garceau 1962). Indeed, Garceau (1962) went so far as to declare that the theory of trauma, haemorrhage and haematoma should be removed from textbooks. The theory of muscle ischaemia was first suggested by Mikulicz (1895), although he also agreed that the muscle was traumatised during birth. Nov#{233}-Josserand and Viannay (1906) suggested that the ischaemia was due to arterial occlusion, secondary to tautening of the sternomastoid muscle through extreme rotation of the head. Middleton (1930) believed that venous, rather than arterial, occlusion was responsible for the ischaemia. Although the theory of ischaemia has been disputed by some writers (notably Hulbert 1950), Adams, Denny-Brown and Pearson (1962, p. 309) considered it to be the most satisfactory explanation of” sternomastoid tumour” and wryneck, since the pathological changes were similar to those of Volkmann’s contracture. These authors noted that there was no agreement as to whether the ischaemia was due to venous or arterial occlusion. We consider the following case worthy of publication, firstly because it proves that severe injury may occur to the sternomastoid muscle during birth and clearly demonstrates the striking histological features of such injury, and secondly because it permits a considered opinion as to the manner of development of the “ sternomastoid tumour” of infancy.