Myotomy
Under myotomy (from the Greek. Mys muscle and τομή "cut") is generally understood the operational division of a muscle . The myotomy can be voluntary (primary) or as part of another operation (secondary). On the other hand, if the tendon that attaches the muscle to a bone is cut, it is called a tenotomy . If the muscle-tendon junction is severed, it can be referred to as a teno myotomy.
Clinical significance
As a rule, the myotomy is carried out transversely to the fiber course, but in principle it is also a myotomy, e.g. B. for resection or transfer of a muscle belly. A transverse transection often leads to heavier bleeding, so that precise hemostasis z. B. is necessary by cauterization .
After complete myotomy, the muscle belly moves through spontaneous contraction back, if it is not fixed by instruments. This leads to a complete loss of function of the muscle. Even if the muscle belly remains withdrawn from the severed muscle residue, a scar still forms. This contracts with further healing and - depending on the distance between the muscle ends after the myotomy - leads to a partial reattachment of the muscle ends. In this way, a certain residual function of the muscle can be preserved.
A secondary required myotomy can e.g. B. the temporary severing of a muscle to create surgical access to deeper body regions, with subsequent restoration (reconstruction) or suture. Myotomies are also necessary for an amputation , the height of which depends on the muscle group, the height of the amputation and the quality of blood flow or the contractibility of the muscle. Amputations are followed by a myoplasty with connecting different muscle groups to cover the bone stump, or a myodesis with attaching the severed muscle directly to the bone.
In the primary sense, a myotomy is performed to e.g. B. to release a (spastic or fibrous) muscle contracture . There are different procedures: tenotomy, tendon lengthening or teno-myotomy. The latter method is z. B. used in pediatric orthopedics for infantile cerebral palsy . One of the most common reasons is a shortening of the triceps surae muscle and the Achilles tendon with the resulting equinus foot . Also in the muscular torticollis ( torticollis ) - especially the congenital form - often comes a myotomy or tenotomy of the sternocleidomastoid muscle into consideration.
A myotomy is also used in gastroenterology for the treatment of achalasia , as well as for the treatment of pyloric stenosis as a pyloromyotomy, or rarely in ophthalmology for the treatment of strabismus (however, tenotomy is more common there).
