Congenital Muscular Torticollis Research Articles

A consensus statement on the use of botulinum toxin in pediatric patients.

Botulinum toxin has been used in medicine for the past 30 years. However, there continues to be controversy about the appropriate uses and dosing, especially in the pediatric population. A panel of nine pediatric physiatrists from different regions and previous training programs in the United States were nominated based on institutional reputation and botulinum toxin (BoNT) experience. Based on a review of the current literature, the goal was to provide the rationale for recommendations on the administration of BoNT in the pediatric population. The goal was not only to review safety, dosing, and injection techniques but also to develop a consensus on the appropriate uses in the pediatric population. In addition to upper and lower limb spasticity, the consensus also provides recommendations for congenital muscular torticollis, cervical dystonia, sialorrhea, and brachial plexus palsies.

Congenital muscular torticollis: an Orl’s perspective

<p>Congenital muscular torticollis usually results from the shortening or excessive contraction of sternocleidomastoid muscle. Delay in diagnosis and appropriate early therapeutic evaluation can lead to permanent disability. We would like to report two rare cases with congenital muscular torticollis who underwent surgery followed by aggressive physiotherapy. We would like to emphasise the need of an early diagnosis and intervention which leads to best outcome. This can prevent progressive physical deformity. Surgeons should offer the patient with option of release and repair of sternocleidomastoid muscle as it gives excellent result in view of mobility and appearance for child.</p>

Fifteen-minute consultation: Evaluation of paediatric torticollis

Torticollis refers to a state in which the neck is twisted due to excessive contraction or shortening of the muscles on one side. Congenital muscular torticollis, which is more common...

Chinese massage (Tuina) combline with paraffin therapy versus tuina or paraffin therapy alone for the treatment of congenital muscular torticollis: A protocol for systematic review and Bayesian network meta-analysis.

Background:Current studies in patients with congenital muscular torticollis (CMT) have predominantly focused on the role of tuina or paraffin therapy alone. This systematic review with Bayesian network meta-analysis will be performed to sum up the existing evidence on the effects and safety of tuina plus paraffin therapy for CMT in infants and children.Methods:The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes reporting guidelines will be followed to conduct this study. The electronic databases of PubMed, Cochrane Library, PsycINFO, EMBASE, the Chinese Scientific Journal Database, China National Knowledge Infrastructure, WanFang Data, Taiwan Electronic Periodical Services, and Web of Science will be searched from the inception to November 2021 using the following key terms: “Tuina,” “traditional Chinese medicine massage,” “paraffin,” and “congenital muscular torticollis,” for all relevant studies. We impose no language restrictions. We include reports on randomized controlled trials (RCTs) and quasi-RCTs of Tuina combline with paraffin therapy for the treatment of CMT in children and adolescents. We include studies that assessed effective rate, symmetry, improvements of range of motion, muscle length, and sternocleidomastoid tumor thickness, quality of life, and adverse events. The Cochrane Bias Risk Tool, which considers sequence generation, allocation concealment, and blinding and other aspects of bias, will be used to assess the risk of bias in studies.Results:A Bayesian network meta-analysis is an appropriate statistical method to compare all treatment options by statistically simulating the estimated results of a comprehensive trial, and to compare treatments by common and associated comparators. In addition, Bayesian network meta-analysis can produce ranking probabilities of treatments, which may contribute to clinicians’ clinical decision-making.Registration number:10.17605/OSF.IO/K5EGN.

The Impact of Surgical Correction in Changing Morphometric Dimensions of Craniofacial Deformities and Facial Asymmetry in Congenital Muscular Torticollis: An Otolaryngologists Perspective.

To evaluate the synergistic occurrence of facial asymmetry and craniofacial deformities in cases of Congenital muscular torticollis (CMT) and to assess the outcome of surgical correction on these deformities. Twenty-three cases of CMT presenting in ENT OPD from January 2015 to December 2019, 9 cases requiring surgical intervention were included. Facial asymmetry and craniofacial deformities were evaluated and quantified by measuring gaze angle, translational deformity and orbito-alar distance. All cases underwent a bipolar tenotomy using harmonic scalpel. In all cases on comparison with preoperative status there was significant improvement (p < 0.05) in surgical outcomes in terms of gaze angle, translational deformity and orbito-alar asymmetry. (1) There is overall excellent outcomes after surgery even when performed for the cases of neglected torticollis. (2) Timely intervention results in near normal improvement of craniofacial deformities. (3) Bipolar tenotomy using harmonic scalpel is safe, effective and complication-free method.

Effectiveness of hydrotherapy in congenital muscular torticollis

Congenital muscular torticollis (CMT); is one of the musculoskeletal diseases seen in the neonatal and infant period. It is formed as a result of stretching the sternocleidomastoid (SCM) muscle in childhood. Due to unilateral contraction of the SCM muscle, ipsilateral head tilt, contralateral face and jaw rotation occur. Exercise and positioning in physical therapy constitute the conservative treatment of CMT. Hydrotherapy treatment has not been used in CMT cases. However, most of the CMT which are not treated early are resolved by surgical intervention. In this case, the effectiveness and success of exercise and hydrotherapy on the patient with CMT were presented.

Is Longstanding Congenital Muscular Torticollis Provoking Pelvic Malalignment Syndrome?

It has been reported that congenital muscular torticollis (CMT) may result in secondary scoliosis over long-term follow-ups. However, there are few reports on whether CMT causes pelvic malalignment syndrome (PMS). This study aimed to investigate the relationship between CMT and PMS and to determine the factors associated with the development of PMS in children with longstanding CMT. Medical records of 130 children with CMT who had long-term follow-up were reviewed retrospectively. The chi-squared test and logistic regression analysis were used to determine which initial clinical parameters contributed to the development of PMS. Among 130 children with CMT, 51 (39.2%) developed PMS with or without compensatory scoliosis during long-term follow-up, indicating a high prevalence of PMS in children with a CMT history. Initial clinical symptoms such as a limited range of motion of the neck or the presence of a neck mass could not predict the development of PMS. Even if the clinical symptoms are mild, long-term follow-up of children with CMT is essential to screen for PMS.

Effect of physical therapy intervention on thickness and ratio of the sternocleidomastoid muscle and head rotation angle in infants with congenital muscular torticollis: A randomized clinical trial (CONSORT).

Background:Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT.Methods and analysis:A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance.Results:After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both).Conclusion:Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age.Trial registration:The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862)

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 right-sided 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, 218 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.

Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial

BackgroundPositional plagiocephaly (PP) is a cranial deformation frequent amongst children and consisting in a flattened and asymmetrical head shape. PP is associated with excessive time in supine and with congenital muscular torticollis (CMT). Few studies have evaluated the efficiency of a manual therapy approach in PP. The purpose of this parallel randomized controlled trial is to compare the effectiveness of adding a manual therapy approach to a caregiver education program focusing on active rotation range of motion (AROM) and neuromotor development in a PP pediatric sample.MethodsThirty-four children with PP and less than 28 week-old were randomly distributed into two groups. AROM and neuromotor development with Alberta Infant Motor Scale (AIMS) were measured. The evaluation was performed by an examiner, blinded to the randomization of the subjects. A pediatric integrative manual therapy (PIMT) group received 10-sessions involving manual therapy and a caregiver education program. Manual therapy was addressed to the upper cervical spine to mobilize the occiput, atlas and axis. The caregiver educational program consisted in exercises to reduce the positional preference and to stimulate motor development. The control group received the caregiver education program exclusively. To compare intervention effectiveness across the groups, improvement indexes of AROM and AIMS were calculated using the difference of the final measurement values minus the baseline measurement values. If the distribution was normal, the improvement indexes were compared using the Student t-test for independent samples; if not, the Mann-Whitney U test was used. The effect size of the interventions was calculated using Cohen’s d.ResultsAll randomized subjects were analysed. After the intervention, the PIMT group showed a significantly higher increase in rotation (29.68 ± 18.41°) than the control group (6.13 ± 17.69°) (p = 0.001). Both groups improved the neuromotor development but no statistically significant differences were found. No harm was reported during the study.ConclusionThe PIMT intervention program was more effective in increasing AROM than using only a caregiver education program.The study has been retrospectively registered at clinicaltrials.gov, with identification number NCT03659032. Registration date: September 1, 2018.

Evaluation of the Clinical Role of Strain Elastography in Patients Diagnosed With Congenital Torticollis

Objective: The objective of this study was to determine the elasticity of sternocleidomastoid muscle (SCM) in patients with congenital muscular torticollis (CMT). Methods: In all, 41 patients and 22 controls were included in the study, and the elasticity of the patients’ SCM was measured. Echogenicity, thickness, and strain values of the SCM were also obtained. Results: The thickness and strain values of the SCM were higher in the patient group than in the control group ( P = .02 and P = .15). For median values, there was no difference in echogenicity and strain. In the strain elastography evaluation of the receiver operating curve (ROC) for muscle echogenicity in the isoechoic muscle group, the specificity and sensitivity were determined to be 100% and 22%, respectively, for the area under the curve (AOC) value of 0.558 (95% confidence interval [CI], 0.424–0.6686), and the cutoff value was &lt;1.4. In the hyperechoic muscle group, the ROC for AUC values was found to be 0.542 (95% CI, 0.411–0.6686), and the cutoff value was &gt;1.4 with 100% sensitivity and 20.75 specificity. Conclusions: The strain elastography technique can be used in the diagnosis of CMT.

Analysis of Clinical Effect of Acupuncture Combined with Massage on Congenital Muscular Torticollis

To investigate the therapeutic effect and safety of acupuncture combined with massage method in the treatment of congenital muscular torticollis. 86 cases of children with congenital muscular torticollis admitted to our outpatient clinic from June 2016 to June 2020 were selected and randomly divided into 43 cases in the treatment group and 43 cases in the control group using the simple numerical table randomization method. The control group was treated with massage method, while the treatment group was treated with acupuncture method in combination with the control group. The changes of ultrasound characteristics, treatment effect and the angle of head deviation and passive neck mobility after treatment were compared and analyzed between the two groups. The results showed that the head deviation angle became smaller in both groups after treatment compared with that before treatment and the difference was statistically significant (p<0.05) and the difference between the head deviation angle before and after treatment in the treatment group was greater than that in the control group and the difference was statistically significant; color Doppler ultrasound dynamically observed the echogenicity of the muscle in the lesion area before and after treatment and found that there was a trend of homogenization. The difference in mass thickness was statistically significant (p<0.05) when comparing the two groups before and after treatment and between groups after treatment. The difference in sternocleidomastoid contracture length was statistically significant (p<0.05) when comparing the two groups before and after treatment, and the difference in syndrome score was statistically significant (p<0.01) when comparing the two groups before treatment; the difference in syndrome score before and after treatment was greater in the observation group than in the control group and the difference was statistically significant (p<0.01). In conclusion, acupuncture combined with massage is an effective treatment for congenital muscular torticollis and it is a treatment method worthy of clinical promotion.

Spontaneous Resolution of a Relapsed Right Neck Mass due to Sternocleidomastoid Hypertrophy in a Congenital Muscular Torticollis Infant

Spontaneous Resolution of a Relapsed Right Neck Mass due to Sternocleidomastoid Hypertrophy in a Congenital Muscular Torticollis Infant

Three-dimensional stereophotogrammetry measurement of facial asymmetry in patients with congenital muscular torticollis: a non-invasive method

The aim of this study was to evaluate three-dimensional (3D) stereophotogrammetry based methods for measuring craniofacial asymmetry in patients with congenital muscular torticollis (CMT). This study focused on the differences in craniofacial asymmetry in CMT patients compared with a healthy control group using 3D photographs. The difference in facial asymmetry between the CMT group and control group was measured using two methods to analyse facial asymmetry in distinct anatomical regions: (1) mirroring and surface-based registration to analyse the overall facial asymmetry; (2) the ‘coherent point drift’ based method. Thirty-one patients with CMT and 84 controls were included in the study. A statistically significant difference was found between the CMT patients and a healthy control group. The measured facial asymmetry for the CMT group was 1.71±0.66mm and for the controls 0.46±0.14mm (P<0.05). A significant difference was found in surface ratio for the cheek, nose and the forehead region (P<0.05). With its minimal invasive character, 3D stereophotogrammetry is a useful tool in measuring the facial asymmetry associated with CMT and to quantify the treatment-induced facial changes. In the future 3D facial data could be used to create a ranking-scale to categorize the severity of facial asymmetry.

Experiences of Parents of Infants Diagnosed With Mild or Severe Grades of Congenital Muscular Torticollis.

The primary purpose of this study was to describe the experiences of parents of infants diagnosed with congenital muscular torticollis (CMT). A secondary purpose was to compare the experiences of parents of infants with mild grades versus severe grades of involvement based on the CMT severity classification system. Through semistructured interviews, a qualitative phenomenological approach of inquiry was used to investigate the lived experiences of 12 parents. Eight themes common to both groups of parents were identified. Findings indicated having an infant with CMT has a significant effect on the parents and other caregivers. Two themes were unique to parents of the infants with severe CMT. Parents are faced with a diagnosis that requires regular therapy visits and a challenging home program. A multimodal approach by clinicians for teaching and supporting parents during the episode of care may best address their unique challenges and stresses.

Commentary on "Associations Between Congenital Muscular Torticollis Severity and Physical Therapy Episode".

Commentary on "Associations Between Congenital Muscular Torticollis Severity and Physical Therapy Episode".

Commentary on "Experiences of Parents of Infants Diagnosed With Mild or Severe Grades of Congenital Muscular Torticollis".

Commentary on "Experiences of Parents of Infants Diagnosed With Mild or Severe Grades of Congenital Muscular Torticollis".

Factors related to the treatment duration of infants with congenital muscular torticollis

Factors related to the treatment duration of infants with congenital muscular torticollis

Associations Between Congenital Muscular Torticollis Severity and Physical Therapy Episode.

To determine how physical therapy utilization varies with Congenital Muscular Torticollis (CMT) Severity Grading Scale, considering episode of care and clinical practice guidelines. A 3-year retrospective medical record review was conducted. Data were collected for 81 infants receiving physical therapy for CMT. Sample and service characteristics are described; 46 complete records (infants 6 months or younger) were analyzed to determine how physical therapy utilization varied across severity grades. Of the 46 infants with complete care episodes, half had fully resolved all asymmetries. Units billed, episode duration, and total visits each increased across CMT severity grades 1 to 3. Cervical rotation restrictions correlated with total units billed, indicating a positive relationship between CMT severity and service utilization. This study supports that as CMT severity increases, physical therapy utilization increases for grades 1 to 3 of the 2018 CMT Severity Grading Scale.

Effectiveness and safety of massage in the treatment of the congenital muscular torticollis: A systematic review and meta-analysis protocol.

Background:Massage has been widely used in the treatment of muscular torticollis in children, but there is no objective and systematic evaluation of the efficacy of various literature, and the efficacy of massage in the treatment of congenital muscular torticollis (CMT) is not clear. The purpose of this study is to evaluate the clinical efficacy and safety of massage in the treatment of muscular torticollis in children.Methods:Relevant randomized controlled trials (RCTs) will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to May 2020. Two reviewers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The RevMan V.5.3 will be used for meta-analysis.Results:This study will provide an assessment of the current state of Chinese massage therapy for the congenital muscular torticollis, aiming to show the efficacy and safety of massage treatment.Conclusion:This study will provide evidence to judge whether massage is an effective intervention for the third lumbar vertebrae transverse process syndrome.INPLASY registration number:INPLASY202070086.