Congenital muscular torticollis: where are we today? A retrospective analysis at a tertiary hospital

Abstract

Background: The congenital muscular torticollis is characterized by a persistent lateral flexion of the head to the affected side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. The majority of the cases resolve with conservative management, with parents/caregivers education and physical therapy. The aim of this study was to assess demographic and clinical characteristics, treatment options, and outcome, amongst infants referred to pediatric rehabilitation consultation due to congenital muscular torticollis. Methods: Retrospective cohort study of infants diagnosed with congenital muscular torticollis between January 2012 and December 2014. Obstetric and perinatal data, clinical presentation, comorbidities, treatment, and outcome were abstracted from clinical records. Results: One hundred six infants were included. There was no sex predominance and mean age at first pediatric rehabilitation consultation was 11.6 (10.4) weeks. Most women were primiparous (76.4%), dystocic labor predominated (73.6%), and pelvic fetal presentation occurred in 20.8%. At examination, 49.1% of the infants had abnormalities, beyond the tilt cervical, mainly range of motion restrictions and palpable nodule in sternocleidomastoid muscle. Among the 87 children who performed the cervical ultrasound, 29 (27.4%) had anomalies. Associated clinical conditions such as hip dysplasia were identified. The majority (71.7%) were submitted to conservative treatment, 30.2% in the Pediatric Rehabilitation Department. Most infants (97.2%) showed a complete resolution of the torticollis. Conclusions: Congenital muscular torticollis is the most common cause of torticollis in the infants. Early diagnosis, parent/caregivers education, and conservative treatment are crucial to achieving good results.

Neurodevelopmental outcomes and comorbidities of children with congenital muscular torticollis: evaluation using the National Health Screening Program for Infants and Children database

“…Although the etiology of CMT remains unclear, birth trauma 23) , perinatal compartment syndrome 24) , and impairment of the developing SCM caused by intrauterine restrictions [25][26][27] are known causes. In addition, breech presentation, multiple pregnancies, primiparity, and dystocic labor are considered risk factors for CMT 14) . However, in our study, we could not investigate risk factors for CMT such as abnormal fetal positioning, continuous neck rotation in utero, and difficult delivery.…”

“…If CMT is not treated early, it can affect the child's appearance, and cause visual impairment and neurodevelopmental delay [9][10][11][12][13] .Conservative treatment of CMT includes home stretching and Physical and Rehabilitation Medicine (PRM) intervention. Postural torticollis identified in an early phase can be rapidly resolved with positioning or simple home stretching, but most cases diagnosed after 3-6 months of age or severe type with SCM mass require longterm exercise therapy by PRM physician 14) . Exercise therapy for CMT includes several A c c e p t e d A r t i c l e components, such as manual stretching of SCM muscle, active rotation exercises, positioning and handling, and environmental adaptation, parent/caregiver education 15) .…”

“…There have been controversies over early treatment in children with CMT. Many studies' results indicated that early interventional treatment can reduce secondary damage or complications in CMT patients 4,14,16) . Other studies reported that most patients spontaneously resolved within the first year of birth 7,17) .…”

Ocular Abnormal Head Posture

“… 81 AHP may affect normal facial development, and previous studies have shown that most of the patients with congenital AHP have facial asymmetry. 2 29 50 82 83…”

“…The term torticollis is mostly used in other sciences, which is derived from two Latin words: Torquere, meaning twisted and collum, meaning neck. 2 Although torticollis is considered a nonspecific term indicating a head and neck tilt following contracture of the sternocleidomastoid muscle, 3 the term “ocular torticollis” has been commonly used in ophthalmology and vision science since 1914. 4 …”