Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study

Farzad Omidi-Kashani,Reza Sharifi,Mahdi Mazlumi,Ebrahim G Hasankhani

doi:10.1186/1471-2474-9-158

Farzad Omidi-Kashani, Reza Sharifi + Show 2 more

Open Access

https://doi.org/10.1186/1471-2474-9-158

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Abstract

BackgroundCongenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot. When diagnosed early, it is obvious that it can be managed with good or excellent results. The aim of this prospective study was to determine the efficacy of surgery in neglected adult cases.MethodsFrom January 2003 to June 2007, 18 adult skeletally matured patients were surgically treated for neglected congenital muscular torticollis and prospectively followed (at least one year). Bipolar release was performed in all patients. Radiography and the modified Lee's scoring system which included function and cosmesis, were used to measure the surgical results. Complications were also recorded.ResultsFour cases were lost during follow-up. Of the remaining 14 patients, 10 cases were males and 4 females. The age at operation ranged from 18 to 32 (average 21.9) years. The mean follow-up period was 2.5 years (range 1–5 years). Excellent results were noted in 7 patients, good in 5, and poor in 2 patients. Significant improvement (>10°) of the cervico-thoracic scoliosis was noted only in 3 of 10 patients.ConclusionPatients with congenital muscular torticollis can benefit from surgical treatment even in adulthood. Surgical bipolar sectioning of the sternocleidomastoid muscle should be considered even in adults with irreversible facial and skeletal deformities. The surgery restores the range of neck motion and resolves the head tilt; therefore it can improve the quality of life. This procedure is an effective and relatively complication-free method.

Highlights

Congenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot
The term congenital muscular torticollis (CMT), a neck deformity primarily involves shortening of the sternocleidomastoid muscle that leads the head to turn toward the affected side and the chin to point to the opposite side, is its most common form and clearly should be
As a result of fibrotic changes of the sternocleidomastoid muscle, the unilateral contracture may subsequently result in plagiocephaly, skull and facial asymmetry [6]

Summary

Introduction

Congenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot. It is obvious that it can be managed with good or excellent results The aim of this prospective study was to determine the efficacy of surgery in neglected adult cases. The term congenital muscular torticollis (CMT), a neck deformity primarily involves shortening of the sternocleidomastoid muscle that leads the head to turn toward the affected side and the chin to point to the opposite side, is its most common form and clearly should be (page number not for citation purposes). CMT is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot [3], with a reported incidence of 0.3–1.9% [4,5]. The indications for surgery were a persistent head tilt (Figure 1), deficits of passive rotation and lateral bending of the neck of >15°, a tight band or tumor in the sternocleidomastoid muscle, and a poor result according to the special assessment chart [16]

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