Características, diagnóstico y tratamiento de la tortícolis muscular congénita

Introducción: La tortícolis muscular congénita es una entidad clínica que se hace evidente al nacimiento o poco después, presenta un amplio espectro de secuelas; algunas de estas, una vez establecidas, pueden requerir complejas y costosas correcciones quirúrgicas. we Objetivo: Caracterizar la tortícolis muscular congénita según elementos clínicos, diagnósticos y terapéuticos. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer cuatrimestre de 2021. Se utilizaron como buscadores de información científica: Pubmed/Medline, SciELO, Scopus y ScienceDirect, así como fuentes oficiales como, China CDC, CDC y FDA. La estrategia de búsqueda incluyó los siguientes términos como palabras clave: tortícolis muscular congénita, complicaciones dentofaciales y psicológicas, plagiocefalia posicional. Se evaluaron artículos de revisión, de investigación y páginas web que, en general, tenían menos de 10 años de publicados, en idioma español e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 90 referencias bibliográficas, de las cuales 30 se citaron en el presente artículo. Conclusiones: La tortícolis muscular congénita es una enfermedad de observancia frecuente, su diagnóstico clínico y por exámenes complementarios debe hacerse en los primeros meses de vida. La detección y tratamiento rehabilitador precoz constituyen las armas fundamentales para evitar sus secuelas dentofaciales y psicológicas.

Introduction: Congenital muscular torticollis is a clinical entity that becomes evident at birth or shortly thereafter. It presents a wide spectrum of sequelae. Some of these, once established, may require complex and costly surgical corrections. Objective: To characterize congenital muscular torticollis according to clinical, diagnostic and therapeutic elements. Methods: A search for relevant literature on the subject was carried out in the first third of 2021. As information search engines Pubmed/Medline, SciELO, Scopus and ScienceDirect were used; as well as official sources, such as China CDC, CDC and FDA. The search strategy included the following keywords: tortícolis muscular congénita [congenital muscular torticollis], complicaciones dentofaciales y psicológicas [dentofacial and psychological complications], plagiocefalia posicional [positional plagiocephaly]. Review articles, research articles and web pages, in Spanish and in English, were assessed by considering that they had generally been published within less than ten years and that they referred, within their title, specifically to the topic of study. The articles that did not meet these conditions were excluded. This allowed the study of ninety bibliographic references, thirty of which were cited in the present article. Conclusions: Congenital muscular torticollis is a frequently observed disease, which should be diagnosed, clinically and by complementary tests, in the first months of life. Early identification and rehabilitation treatment are the fundamental weapons to avoid its dentofacial and psychological sequelae.

Caracterización clínica, radiológica y epidemiológica de niños con secuelas de tortícolis muscular congénita / Clinical, radiological, and epidemiological characterization of children with sequelae of congenital muscular torticollis / Caracterização clínica, radiológica e epidemiológica de crianças com sequelas de torcicolo muscular congênito

RESUMEN Introducción: Las secuelas de la tortícolis muscular congénita en niños tiene un amplio espectro, algunas de las cuales, una vez establecidas pueden requerir complejas y costosas correcciones quirúrgicas. Objetivo: Caracterizar las secuelas de tortícolis muscular congénita según elementos clínicos, radiológicos y epidemiológicos en niños atendidos en Santiago de Cuba en el periodo 2017-2020. Método: Estudio prospectivo-analítico de caso-control en 112 niños con dicha enfermedad, separados en casos (24 niños) y controles (88 niños). El procesamiento de datos implicó análisis de frecuencias, cálculo de Ji-cuadrado, identificación de factores asociados a variable dependiente, cálculo del valor de p y Odds ratio. Resultados: Se obtuvo predominio de población masculina en casos (70,8 %) y controles (68,2 %), con asociación estadística entre edad ≥ 6 meses al momento del diagnóstico y presencia de complicaciones (OR: 2,4-20,4; p=0,00). Existió asociación estadística entre macrosomía al nacer y presencia de complicaciones en 25,0 % de casos y 11,4 % de controles (OR: 1,9-12,5; p=0,02). Hubo asociación estadística entre inicio tardío del tratamiento rehabilitador y complicaciones (OR: 2,86-21,3; p=0,00). Conclusiones: Se observó predominio de complicaciones orgánicas o comorbilidades en varones, siendo más probable el incremento significativo de secuelas en estos y cuando se inicia el tratamiento médico después de los 6 meses de edad. Las complicaciones más frecuentes fueron: asimetría facial, plagiocefalia y asociación de dos o más secuelas.

ABSTRACT Introduction: Sequelae of congenital muscular torticollis in children have a wide spectrum, some of which, set already, may require complex and costly surgical corrections. Objective: To characterize the sequelae of congenital muscular torticollis according to clinical, radiological, and epidemiological elements in children attended in Santiago de Cuba from 2017 to 2020. Method: Prospective-analytical case-control study in 112 children with this disease, separated in cases (24 children) and controls (88 children). Data processing involved frequency analysis, calculation of chi-square, identification of factors associated with dependent variable, calculation of the p-value and OR. Results: The male population predominated in cases (70.8%) and controls (68.2%), with a statistical association between age ≥ 6 months at diagnosis and the presence of complications (OR: 2.4-20.4; p=0.00). There was a statistical association between macrosomia at birth and the presence of complications in 25.0 % of cases and 11.4 % of controls (OR: 1.9-12.5; p=0.02). There was a statistical association between late initiation of rehabilitation treatment and complications (OR: 2.86-21.3; p=0.00). Conclusions: A predominance of organic complications or comorbidities was observed in males, with a significant increase of sequelae in this group and also when medical treatment is started after 6 months of age. The most frequent complications were facial asymmetry, plagiocephaly and association of two or more sequelae.

RESUMO Introdução: As sequelas do torcicolo muscular congênito em crianças têm amplo espectro, algumas das quais, uma vez estabelecidas, podem exigir correções cirúrgicas complexas e onerosas. Objetivo: Caracterizar as sequelas do torcicolo muscular congênito segundo elementos clínicos, radiológicos e epidemiológicos em crianças atendidas em Santiago de Cuba no período 2017-2020. Método: Estudo prospectivo-analítico caso-controle em 112 crianças com essa doença, separadas em casos (24 crianças) e controles (88 crianças). O processamento dos dados envolveu análise de frequência, cálculo do Qui-quadrado, identificação dos fatores associados à variável dependente, cálculo do valor de p e Odss ratio. Resultados: Obteve-se predominância da população masculina nos casos (70,8%) e controles (68,2%), com associação estatística entre idade ≥ 6 meses no momento do diagnóstico e presença de complicações (OR: 2,4-20,4; p=0,00). Houve associação estatística entre macrossomia ao nascimento e presença de complicações em 25,0% dos casos e 11,4% dos controles (OR: 1,9-12,5; p=0,02). Houve associação estatística entre início tardio do tratamento de reabilitação e complicações (OR: 2,86-21,3; p=0,00). Conclusões: Observou-se predominância de complicações orgânicas ou comorbidades no sexo masculino, com aumento significativo de sequelas sendo mais provável nestes e quando o tratamento médico é iniciado após os 6 meses de idade. As complicações mais frequentes foram: assimetria facial, plagiocefalia e associação de duas ou mais sequelas.

Effect of botulinum toxin type a in congenital muscular torticollis / 中华医学美学美容杂志

Objective:To discuss the clinical results of treatment for congenital muscular torticollis with different injection points of botulinum toxin type A and traditional conservative method, and to expound the safety and effectiveness of this way.Methods:From January 2018 to December 2018, 60 cases aged from one month to six months with congenital muscular torticollis who visited the outpatient clinic of plastic surgery in Children＇s Hospital of Quanzhou, a teaching hospital of FuJian Medical University, and there were 38 males and 22 females. The treatment groups were divided into two groups according to random number method that were treated with botulinum toxin type A: the single point group was given one point injection, and the three-point group was injected with three points, while the control group was treated with traditional conservative treatment (mainly manual stretching exercises). The number of cases in each group was 20.Results:The differences of muscle thickness and muscle length were repeatedly measured at different time points in the same group and variance analysis conducted. The results showed that there were statistical significances among the two indicators at different time points in each group ( P<0.05). Least significant difference (LSD) was further adopted for pairwise comparison between indicators at different time points in each group and the differences were statistically significant ( P<0.05). In the comparison of treatment effect of different groups after twelve months follow-up, the cure rate was 85% (17 cases) in the single point group, 95 % (19 cases) in the three-point group, and 80 % (16 cases) in the control group, there was no significant difference among three groups ( P>0.05). Conclusions:Local injection of botulinum toxin type A is a safe and effective treatment option for congenital muscular torticollis, which can achieve the same clinical effect as traditional conservative treatment.

Congenital muscular torticollis severity classifications in the diagnosis and prognosis of infants′ congenital muscular torticollis / 中华物理医学与康复杂志

Objective:To explore the value of congenital muscular torticollis severity classification scores (CMT-SCSTs) in the diagnosis and prognosis of infants′ congenital muscular torticollis (CMT).Methods:A total of 89 CMT children were examined using ultrasound to determine the size of the affected side and the contralateral sternocleidomastoid mass or the abnormal area of the muscle fringe echo from the head and neck. They were also rated using CMT-SCST scoring. They were then given 15 minutes of massage once a day and 5 minutes postural correction twice a day for 3 to 6 months. They were reviewed using ultrasound and the CMT-SCST 3 and 6 months later.Results:The number of treatments was negatively correlated with the initial CMT-SCST score. For those with a baseline CMT-SCST score ≥7 it was effective after 3 and 6 months. Those with a baseline CMT-SCST score ≥9 were almost cured after 3 and 6 months. Gender, age, signs of hip dysplasia, and comorbid global developmental delay (GDD) were not consistently related to the severity and the outcome of CMT. The CMT-SCST was more sensitive in prognosis than the CMT-SCS published in 2013.Conclusions:CMT-SCST scoring provides a theoretical foundation for the diagnosis and treatment and evaluation of infants with CMT. It deserves wider popularity and application in clinical practice.

Clinical analysis and prognosis of reoperation of congenital muscular torticollis in 12 children / 中华实用儿科临床杂志

Objective:To explore the clinical characteristics and short-term prognosis of reoperation of congenital muscular torticollis (CMT).Methods:A total of 12 cases of recurrent CMT treated in the First Affiliated Hospital of Zhengzhou University from May 2015 to May 2018 were recruited, involving 9 boys and 3 girls with the mean age of 13.2 (8-16) years.The causes of disease recurrence were analyzed, and the postoperative appearance of the children was observed by follow-up.In addition, the prognosis of CMT was evaluated by patient satisfaction survey and Lee score criteria.Results:Among the 12 patients, 10 cases were treated in other hospitals and 2 cases in this hospital.The age of the first surgery ranged from 6 months to 2.2 years.Surgical methods included minimally invasive small needle knife (2 cases), single head release of small incision (5 cases), simple amputation (7 cases) and broken end silk thread ligation (4 cases). During the second surgery, contracture and adhesion of sternocleidomastoid muscle at varying degrees were confirmed, including contracture and adhesion of platysma muscle (3 cases), difficulty in separation of jugular sheath (8 cases), and repair of rupture of internal jugular vein (2 cases). Bipolar release of sternocleidomastoid muscle was performed in all surgeries, and tension-free alignment of the neck to the midline was the complete basis for release.The postoperative appearance of all children was satisfied.They were followed up for an average of 2.3 (1.2-3.0) years.Nine and 3 cases graded more than 90 and 80 patient satisfaction scores, respectively.Lee scores reflected the range of motion of head and neck, and the distance and degree of head deviation from the midline, which yielded excellent, good and fair in 12 cases, 8 cases and 3 cases, respectively.Conclusions:Incomplete release is believed as the basic cause of recurrence in children with CMT.Meanwhile, muscle scar adhesion, early operative age, minimally invasive incision and lack of postoperative rehabilitation may also be the direct factors for CMT recurrence.For recurrent patients, satisfactory therapeutic effect can be achieved through bipolar release, especially complete release of the lower pole, combined with postoperative neck traction, fixation and rehabilitation exercise.

Prognostic Factors in Recurrent Congenital Muscular Torticollis

@#Introduction: Congenital muscular torticollis (CMT), primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle. One of the common surgical complications is recurrent deformity. However, the associations between unipolar or bipolar release, age of the patient, and the recurrence of the disease are unclear. Therefore, the purpose of this study was to evaluate the factors associated with recurrence after surgery. Materials and Methods: A retrospective review was performed in 47 patients who were diagnosed with CMT and had been treated surgically with unipolar or bipolar release between January 2007 and December 2015. Demographic data (sex, sides, surgical technique, age at time of surgery, period of follow-up, complications and recurrence) were recorded. Results: Forty-seven patients with an average age of 8.7 years old at time of surgery. Twenty-six patients had rightsided muscular torticollis, while 21 had left-sided. The average follow-up time was 2 years (range, 2–4 years). The average age of unipolar release was 8.8 years old (range, 2- 18 years old), while the average age of bipolar release was 8.7 years old (range, 2–13 years old). Recurrence occurred in 11 patients (9 in unipolar and 2 in bipolar release). Sex, side of deformity, type of surgery and age at time of surgery showed no statistically significant as a factor for recurrence rate, however recurrence of unipolar more than bipolar surgery was nearly two times revealing clinical significance. Conclusions: Sex, side of deformity, type of surgery and age at time of surgery were not associated with the recurrence deformity.

Effect of Integrative Medicine on Infant with Congenital Muscular Torticollis / 中国康复理论与实践

Objective:To study the efficacy of integrative medicine on congenital muscular torticollis. Methods:From October, 2017 to September, 2019, 80 children with congenital muscular torticollis were divided into group 1 (n = 40) and group 2 (n = 40) according to different treatment schemes. Group 1 received comprehensive physiotherapy, including passive stretching, head control training, posture correction and family rehabilitation. Group 2 received Tuina in addition. Before and six months after treatment, the root mean square (RMS) of surface electromyography of bilateral sternocleidomastoid muscles in supine neutral position, neck rotation and stretch, and the range of motion of passive neck rotation and lateral flexion, and the angle of head deviation from the midline to the affected side were compared. Results:Before treatment, the RMS of sternocleidomastoid muscle in each position was lower in the affected side than in the healthy side (P < 0.01), and the range of motion of neck when lateral flexion to the healthy side and rotation to the affected side was less than that of the other side (P < 0.01) in both groups; however, no significant difference was found between two groups (P > 0.05). After treatment, the RMS of EMG of sternocleidomastoid muscle in each position, and the range of motion of neck when lateral flexion to the healthy side and rotation to the affected side improved (|t| > 3.290, P < 0.01) in both groups, and were better in group 2 than in group 1 (t > 2.401, P < 0.05); the angle of head deviation from the midline to the affected side significantly decreaed (t > 15.075, P < 0.001) in both groups, and was significantly less in group 2 than in group 1 (t = -4.971, P < 0.001). Conclusion:Integrative medicine is effective on infant with congenital muscular torticollis, which is superior to comprehensive physiotherapy only.

Algunos aspectos clínicos e imagenológicos de la tortícolis muscular congénita en menores de 2 años / Some clinical and imaging features of congenital muscular torticollis in children aged under two years

Introducción: La curación de las secuelas dentofaciales de la tortícolis congénita, una vez establecidas, solo puede lograrse mediante cirugías. La identificación temprana de los pacientes aquejados de esta dolencia y un tratamiento precoz es imprescindible, pues de ello dependerá la evolución a largo plazo de los mismos. Objetivo: Identificar los factores que pueden tener utilidad desde la perspectiva de la prevención primordial de la tortícolis congénita. Métodos: Se realizó una investigación observacional, longitudinal y prospectiva en pacientes con diagnóstico de tortícolis muscular congénita atendidos en el Policlínico de Especialidades del Hospital Infantil Sur de Santiago de Cuba, en el periodo de septiembre de 2016 a septiembre de 2018. La muestra fue de 20 pacientes con dicho diagnóstico. Las variables fueron agrupadas en clínicas e imagenológicas. Resultados: Predominaron los pacientes del sexo masculino, 14 casos (70 por ciento). El diagnóstico de la mayoría de los casos fue precoz, 3 (15 por ciento) en la etapa neonatal y 14 (70 por ciento) entre los 29 días y 6 meses. Las complicaciones más temidas tales como la asimetría facial, la deformidad plagiocefálica, la distopia orbitaria y auricular aparecieron sobre todo asociadas a un diagnóstico y tratamiento tardío. La tomografía axial computarizada solo superó a las radiografías para descubrir complicaciones neurológicas. Conclusiones: La atención a temprana edad es la mejor opción terapéutica para evitar complicaciones en niños con tortícolis muscular congénita(AU)

Introduction: Once established, dentofacial sequels of congenital torticollis can only be healed by surgery. Early identification of sufferers and timely treatment are indispensable to achieve a favorable long-term evolution. Objective: Identify potentially useful factors from the perspective of fundamental prevention of congenital torticollis. Methods: An observational longitudinal prospective study was conducted of patients diagnosed with congenital muscular torticollis attending the Secondary Care Polyclinic at the South Children's Hospital in Santiago de Cuba from September 2016 to September 2018. The sample was 20 patients diagnosed with the disease. The variables analyzed were grouped into clinical and imaging. Results: There was a predominance of male patients with 14 cases (70 percent). Diagnosis of most cases was performed early: 3 (15 percent) at the neonatal stage and 14 (70 percent) between 29 days and 6 months. The most feared complications, such as facial asymmetry, plagiocephalic deformity, and orbital and auricular dystopia, were mainly found to be associated to late diagnosis and treatment. Computed axial tomography only surpassed radiography in spotting neurological complications. Conclusions: Early care is the best therapeutic option to prevent complications in children with congenital muscular torticollis(AU)

Congenital Muscular Torticollis: A Case Report

@#<p><strong>OBJECTIVE: </strong>To discuss a case of congenital muscular torticollis and its presentation, pathophysiology and management. </p><p><strong>METHODS: </strong></p><p>                    <strong>Design: </strong>Case Report</p><p>                    <strong>Setting: </strong>Tertiary Private Hospital</p><p>                    <strong>Patient: </strong>One</p><p><strong>RESULTS: </strong>An 11-year-old girl presented with tilting of head to the right and progressive limitation of head movement since infancy. MRI showed a shortened right sternocleidomastoid muscle. The patient underwent surgical release of torticollis. Full range of motion of the neck was achieved after the surgical management.</p><p><strong>CONCLUSION</strong>: Congenital torticollis is a rare condition of the head and neck region. Physicians should be familiar with this entity and its presentation and it should be considered in the differential diagnosis of patients with progressive limitation of head movement in order to initiate early treatment and avoid progressive physical deformity.</p><p> </p><p><strong>KEYWORDS: </strong>congenital muscular torticollis; familial spasmodic torticollis</p>

Secondary Cervicothoracic Scoliosis in Congenital Muscular Torticollis

BACKGROUND: Although secondary cervicothoracic scoliosis frequently occurs in patients with congenital muscular torticollis (CMT), the relationship between scoliosis and CMT has not been evaluated. This study aims to evaluate the effects of surgical release of sternocleidomastoid (SCM) muscle on secondary cervicothoracic scoliosis in patients with CMT and determine factors affecting the improvement of scoliosis after surgical release of SCM muscle. METHODS: Eighty-seven of the 106 patients, confirmed as having secondary cervicothoracic scoliosis with CMT with a minimum 1-year follow-up, were included in this study. Preoperative and last follow-up radiologic outcomes were assessed for the cervicomandibular angle (CMA), Cobb angle of the cervicothoracic scoliosis, and direction of convexity in the scoliosis curve. Patients were divided into two groups to assess the improvement of Cobb angle according to residual growth potential; age ≤ 15 years and > 15 years. The improvement of Cobb angle after surgical release was compared in the two groups. Correlation analysis and multivariable regression analysis were performed to determine the factors affecting the improvement of scoliosis. RESULTS: All the radiologic parameters, such as the Cobb angle and CMA, improved significantly after surgical release (p 15 years (p < 0.001). The improvement of Cobb angle was significantly correlated with age (r = −0.474, p < 0.001) and the preoperative Cobb angle (r = 0.221, p = 0.036). In multivariable regression analysis, age and preoperative Cobb angle were shown to be predisposing factors affecting the improvement of scoliosis. CONCLUSIONS: The results showed that SCM release can be a beneficial treatment for secondary cervicothoracic scoliosis. The improvement of scoliosis was greater when the SCM release was performed before the patient reached the end of growth.

Effect of Home-based Rehabilitation on Congenital Muscular Torticollis / 中国康复理论与实践

Objective:To explore the effect of home-based rehabilitation on children with congenital muscular torticollis (CMT). Methods:From January, 2016 to January, 2018, 60 children with CMT were randomly divided in to control group (n = 30) and observation group (n = 30). Both groups received comprehensive physical therapy; the observation group received home-based rehabilitation in addition. Three months after treatment, the sternocleidomastoid thickness, severity classification of CMT, and clinic effect were compared. Results:After treatment, the sternocleidomastoid thickness decreased in both groups (t > 9.862, P < 0.001), and was better in the observation group than in the control group (t = 5.468, P < 0.001); the severity classification of CMT decreased in both groups (|Z| > 5.857, P < 0.001), and was better in the observation group than in the control group (Z = -2.226, P < 0.05), as well as the clinical effect (U = 2359, P = 0.018). Conclusion:Home-based rehabilitation combined with comprehensive physical therapy is superior to comprehensive physical therapy only.

The application of shear wave elastography in sternocleidomastoid muscle in the early diagnosis of congenital muscular torticollis in infantile infants / 中华医学超声杂志（电子版）

Objective To discuss the application of shear wave elastography and strain elasticity imaging diagnosis of infants with congenital muscular torticollis. Methods Children with congenital muscular torticollis in 50 patients and 100 healthy infants were recruited for the research at Shezhen Children′s Hospital in the period of September to December, analyzing factors in normal sternocleidomastoid two mode ultrasonic elastography, including the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results, comparing the change of elasticity between the patients and normal. Results The elastic parameters of the sternocleidomastoid showed no statistically significant difference between the genders, the left side and the right side. The results of young′s modulus, shear wave velocity and shear wave modulus were higher in long axis section than the short axis section, and the difference was statistically significant (P<0.05). However, the results of the strain ratio and thickness was not statistically significant. The young′s modulus, shear wave velocity and shear wave modulus are higher in the stretch back position than symmetrical supine position, and the difference is statistically significant (P<0.05). But those of strain ratio and thickness was not statistically significant. The thickness of the sternocleidomastoid muscle and the young′s modulus, shear wave velocity, shear modulus and the ratio of strain results ultrasound elastic results were higher in the lesion side than the healthy side, and the difference is statistically significant (P<0.05). Conclusion The ultrasound elastic imaging of multimodal technique can quantify the elasticity of the normal infant and the patients sternocleidomastoid, be used for diagnose for the infants with the congenital muscular torticollis.

Clinical Usefulness of Sonoelastography in Infants With Congenital Muscular Torticollis

OBJECTIVE: To evaluate the clinical usefulness of sonoelastography in infants with congenital muscular torticollis (CMT). METHODS: The medical records of 215 infants clinically diagnosed with CMT were retrospectively reviewed. Fifty-three infants met the inclusion criteria as follows: 1) infants diagnosed as CMT with a palpable neck mass before 3 months of age, 2) infants who were evaluated initially by both B-mode ultrasonography and sonoelastography, and 3) infants who had received physical therapy after being diagnosed with CMT. We checked the thickness of the sternocleidomastoid (SCM) muscles in B-mode ultrasonography, strain ratio of the SCM muscles in sonoelastography, and treatment duration. We evaluated the correlation between the treatment duration and the following factors: SCM muscle thickness, ratio of SCM muscle thickness on the affected to unaffected side (A/U ratio), and strain ratio. RESULTS: Both the thickness of the affected SCM muscle and the A/U ratio did not show significant correlation with the treatment duration (p=0.66, p=0.90). The strain ratio of the affected SCM muscle was significantly greater than that of the unaffected SCM muscle (p<0.001), and the strain ratio showed significant correlation with the treatment duration (p=0.001). CONCLUSION: Sonoelastography may be a useful adjunctive tool to B-mode ultrasonography for evaluating infants with CMT, especially when predicting their rehabilitation outcomes.

Effectiveness of Surgical Release in Patients With Neglected Congenital Muscular Torticollis According to Age at the Time of Surgery

OBJECTIVE: To identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT). METHODS: This was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery. RESULTS: The median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046). CONCLUSION: We assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.

A Rare Case of Neglected Congenital Muscular Torticollis in an Adult and Review of Literature.

Aim: We report a rare case of congenital muscular torticollis in an adult and review most of the different treatment approaches reported by authors. Presentation of Case: A 25 year old woman who underwent an unsuccessful surgery for her congenital torticollis in the childhood, presented to our department for the same problem. We performed a unipolar release of the sternocleidomastoid muscle with a large dissection and a resection of a fibrous part of the clavicular head followed by a muscular rehabilitation. Result was satisfactory with an 18 month follow-up. Discussion: Congenital muscular torticollis is rarely seen in adults. There are almost as many treatment protocols for congenital muscular torticollis as authors, with unequal outcomes. Surgical treatments give the best results in adults. We review most of the treatment protocols described in the literature. Conclusion: As surgeons, we have to deal with every special situation in the aim of respecting the integrity of healthy tissues and providing the best care for good functional and cosmetic outcome.

Clinical Observation of Kneading Pull-turning Methods together with the Family Care and Treatment for Children Congenital Muscular ;Torticollis / 浙江中医药大学学报

Objective] To study the effect of kneading pull-turning methods together with the family care and treatment on children congenital muscular torticollis. [Methods] 60 cases of congenital muscular torticollis were randomly divided into kneading pull-turning methods together with the family care group(treatment group) and conventional massage group(control group) with symptoms, signs and evaluation of clinical curative effect between groups of children. [Results] The treatment group cure rate was 76.67%, control group cure rate was 43.33%, the curative effect of treatment group was obviously better than the control group(P<0.05). [Conclusion] Kneading pull-turning methods together with the family care in treatment of children with congenital muscular torticollis has the characteristics of high cure rate which is conducive to recovery of affected children.

Craniofacial Asymmetry in Adults With Neglected Congenital Muscular Torticollis

OBJECTIVE: To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT). METHODS: Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects > or =18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation. RESULTS: The age at CT was 27.71+/-7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p0.05). CONCLUSION: Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.

The Cervical Range of Motion as a Factor Affecting Outcome in Patients With Congenital Muscular Torticollis

OBJECTIVE: To investigate the factors affecting rehabilitation outcomes in children with congenital muscular torticollis (CMT). METHODS: We retrospectively reviewed the medical records of 347 patients who were clinically suspected as having CMT and performed neck ultrasonography to measure sternocleidomastoid (SCM) muscle thickness. Fifty-four patients met the inclusion criteria. Included were demographic characteristics as well as measurements of cervical range of motion (ROM), SCM muscle thickness, and the abnormal/normal (A/N) ratio, defined as the ratio of SCM muscle thickness on the affected to the unaffected side. RESULTS: Subjects were divided into three groups depending on degree of cervical ROM (group 1A: ROM>60, n=12; group 1B: 60> or =ROM>30, n=31; group 1C: ROM or =1.4 cm, n=13), and the A/N ratio (R) (group 3A: R or =2.8, n=15). We found that more limited cervical ROM corresponded to longer treatment duration. The average treatment duration was 4.55 months in group 1A, 5.87 months in group 1B, and 6.50 months in group 1C. SCM muscle thickness and the A/N ratio were not correlated with treatment duration. CONCLUSION: Infants with CMT who were diagnosed earlier and had an earlier intervention had a shorter duration of rehabilitation. Initial cervical ROM is an important prognostic factor for predicting the rehabilitation outcome of patients with CMT.

Screening for the Coexistence of Congenital Muscular Torticollis and Developmental Dysplasia of Hip

OBJECTIVE: To investigate the coexistence rate and related factors of developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT), and to determine whether ultrasonography (US) gives good value for screening of DDH in CMT. METHOD: We prospectively examined 121 infants (73 males and 48 females) diagnosed with CMT to determine the incidence of DDH by US. We also assessed the relationship between neck US findings and DDH occurrence, and investigated the clinical features of CMT related to DDH. RESULTS: 18 patients (14.9%) were diagnosed as having DDH by US. However, most DDH was subclinical and spontaneously resolved. Only 2 patients (1.7%) needed to be treated with a harness. The positive predictive value of clinical examinations for DDH was 52.6% and patients treated by harness were all clinically positive. DDH was more common in the left side (13 left, 4 right, 1 both), but 6 out of 18 DDH (33.3%) cases presented on the contralateral side of CMT. Sex difference was not observed. Breech presentation and oligohydramnios were not related to DDH occurrence. Neck US findings did not correlate with DDH occurrence. CONCLUSION: The coexistence rate of CMT and DDH was concluded to be 14.9%. If only DDH cases that required treatment were included, the coexistence rate of these two disorders would be lowered to 1.7%. All of these patients showed positive findings in clinical examination. Therefore, hip US should not be recommended routinely for patients with CMT.

Factors Affecting Rehabilitation Outcome of Congenital Muscular Torticollis

OBJECTIVE: To explore the factors affecting rehabilitation outcome of congenital muscular torticollis (CMT) patients and suggest the onset time, method and the duration of the rehabilitation treatment. METHOD: 112 patients diagnosed as CMT were enrolled and we reviewed the patients' charts and radiologic findings, retrospectively. We reviewed the sex, gestational age, birth weight, mode of delivery, age at diagnosis, mass thickness, ratio of mass thickness, mass site, plagiocephaly, clavicle fracture, the frequency of rehabilitation treatment. RESULTS: The patients with a plagiocephaly or a clavicle fracture had been needed significantly longer rehabilitation and ratio of mass thickness and rehabilitative duration had a positive linear relationship and diagnostic time and the duration of rehabilitative treatment showed a positive correlation. However, rehabilitation frequency did not equate to a shorter rehabilitation period and mass site did not correlate with the duration of rehabilitation treatment. Also, the group treated with manipulation with additional ultrasound treatment showed no significant difference to the group treated with only manipulation. In this study, 2 patients received surgical treatment, which was SCM tenotomy of the affected side in conjunction with rehabilitation therapy. CONCLUSION: This study showed that plagiocephaly, clavicle fracture, mass ratio, and diagnosis time are clinically significant in determining rehabilitative treatment. So, it is imperative to make a timely diagnosis and objectively evaluate the tilting of the head and neck, as well as checking the mass ratio and identifying the presence of clavicle fractures.