Case Report M to T Rearrangement: An Approach to Correct Webbed Neck Deformity Ananth S. Murthy 1 and Margeaux McGraw 2 1 Division of Plastic Surgery, Akron Children’s Hospital, One Perkins Square, Akron, OH 44308, USA 2 e University of Toledo College of Medicine, Toledo, OH 43606, USA Correspondence should be addressed to Ananth S. Murthy; amurthy@chmca.org Received 19 August 2013; Accepted 31 October 2013; Published 6 January 2014 Academic Editor: Elijah Dixon Copyright © 2014 A. S. Murthy and M. McGraw. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. For the Noonan syndrome patient, the most concerning physical defect is oten congenital webbing of the neck or pterygium colli. We present a patient with pterygium colli and a low and laterally displaced nuchal hairline. Since its description, various surgical approaches have been implemented to correct the deformity. Previously reported posterior and lateral approaches have notable disadvantages with regard to hairline displacement and recurrence. In order to address these disadvantages, a new surgical technique was used on this patient. We have termed this technique an M to T rearrangement. Using a lateral approach, the M and T incisions are made and the trapezial fascial web is directly visualized and able to be completely excised. his prevents the recurrence seen with the use of posterior techniques. Inferolateral displacement of hair-bearing skin can be removed with resection of the superior intervening triangle and improves the appearance of the low nuchal hairline. he excision of excess skin along with the zig-zag closure also prevents postoperative scar contraction and recurrence. An important efect of this technique is the prevention of anterior displacement of hair bearing skin. M to T rearrangement is an efective technique for the correction of webbed neck deformities seen in Noonan and Turner syndromes. 1. Introduction A syndrome involving valvular pulmonary stenosis, small stature, hypertelorism, mild mental retardation, undescend- ed testes, and skeletal abnormalities was irst described by Noonan and Ehmke in 1963 [1]. Noonan syndrome is charac- terized by short stature, congenital heart defect, and develop- mental delay of variable degree. Other indings can include broad or webbed neck, pectus deformity, cryptorchidism, characteristic facies, varied coagulation defects, lymphatic dysplasias, and ocular abnormalities [2]. he syndrome is fairly common, as the incidence is estimated to be approxi- mately 1 : 1,000–2,500 live births [3]. An autosomal dominant pattern of inheritance has been determined and attributed to missense mutations in the PTPN11 gene on chromosome 12 in 50% of cases [4]. For the Noonan syndrome patient, the most concerning physical defect is oten congenital webbing of the neck or pterygium colli. Kobylinski initially reported this deformity in 1883 and the name “pterygium colli” was coined by Funke in 1902 [5, 6]. Pterygium colli involves an ectopic ibrotic facial band supericial to the trapezius muscle. Excess hair- bearing skin is also present and extends down the cervical region well beyond the normal hairline. Since its description, various surgical approaches have been implemented to correct the deformity. Previously reported posterior and lateral approaches have notable disad- vantages with regard to hairline displacement and recurrence. In order to address these disadvantages, a novel surgical technique was used on this patient. We have termed this technique an M to T rearrangement. 2. Case Report A 13-year-old male was evaluated for congenital webbing of the neck secondary to Noonan syndrome. he patient presented with characteristic features of pterygium colli with a low and laterally displaced nuchal hairline. Presurgical testing did not reveal any coagulation abnormalities. hese patients can oten have speciic factor deiciency or platelet Hindawi Publishing Corporation Case Reports in Medicine Volume 2014, Article ID 682806, 5 pages http://dx.doi.org/10.1155/2014/682806