Torticollis is a deformity of neck that shows tilting of the head toward the affected side and rotation of the chin toward the opposite side. In many cases with this condition, unilateral tightness of the sternocleidomastoid muscle is found
frequently
with fibrous tumor.
For the infants with this deformity, stretching of the involved sternocleidomastoid muscle with specific handling and positioning used to be instituted.
A retrospective review of 95 patients with congenital muscular torticollis seen between 1986 and 1991 was performed. In 30 cases, it was supplemented by questionnaires, permitting a eight- to 71-month follow up.
@ES The results were as follows:
@EN 1) There were 51 males and 44 females. Fifty four cases were on the right side forty cases on the left side, and one case was of bilaterality. There was no sex difference between male and female, with favor in former side, but significant
difference
between the right and left side(p<0.01).
2) Torticollis was mild to moderately severe in 77.9% of cases. The mass in the sternocleidomastoid muscle or bead tilting was found before eight weeks of age for 92.6% of patients. The first visit to the clinic before eight weeks was made in
59.0%,
and before 6 months in 85.3%.
3) There were normal spontaneous delivery in 60.0%, instrumental delivery in 12.6%, and by Cesarean section in 27.4%. The breech presentation was 19 cases(20.0%).
4) Associated deformity initially was observed in 14.7% of cases, which included strabismus, dislocation of hip, and scoliosis.
5) At 16 weeks, the torticollis had been conservatively resolved in 46.3%.
6) Torticollis has been completely resolved in 70.3% of patients when treated berore 12 weeks of age, but only in 32.3% when treated after 12 weeks. And also, torticollis has been resolved in 77.8% of patents when treated over 30 times, but
44.0%
when
treated under 30 times.
7) Of the 30 cases with follow up, 11 cases (36.6%) improved. 17 cases(56.7%) remained the same as the condition when conservative treatment terminated, and 2 cases (6.7%) became worse. 6 children had surgical release of sternocleidomastoid
muscle
with
early diagnosis seems more successful in recovery than no exercise although natural resolution may occur in many cases.
|