Custom neck orthosis in combination with onabotulinumtoxinA for the treatment of refractory congenital muscular torticollis: A case report.

PURPOSE: This case report examines the use of a custom neck orthosis following onabotulinumtoxinA (BoNT-A) injections for the treatment of congenital muscular torticollis (CMT) that has not been responsive to conservative treatment or previous injections. METHODS: The patient was fitted for a custom neck orthosis following BoNT-A injections for refractory CMT. Clinical outcomes were evaluated with head tilt, cervical rotation, and neck passive range of motion (PROM) measurements. Parental reports of patient tolerance of the orthosis and family satisfaction of results were obtained through survey. RESULTS: With use of the orthosis following BoNT-A injections, the patient's head tilt improved from 45° to an intermittent tilt of 10° and neck PROM to the left improved from 70° to 90°. He wore the neck orthosis for 8 to 10 hours per day for 3 months, experienced no major complications, and tolerated it well. On follow-up survey, the family reported satisfaction with the results. CONCLUSION: This case provides evidence that a custom neck orthosis after BoNT-A injection may be an effective treatment of refractory CMT before or replacing surgical intervention.

Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.