We retrospectively reviewed 164 infants with congenital muscular torticollis who had been treated conservatively at the Division of Pediatric Surgery, Taegu Fatima Hospital from March 1985 to December 1991. Of special interests in the review were
what
form of treatment should be employed? And is it reasonable that surgical treatment applied to the infants with congenital muscular torticollis?
The boys outnumbered the girls in the ratio of 1.5:1, and the majority of patients, 89.6% were before the age of 3 months. There was a slightly higher incidence on the right(58.5%) with a cases of unusual bilateral invovements. It seemed that
birth
trauma may be related to the etiology of congenital muscular torticollis based on the evidence that first born babies accounted for 68.2% with a high incidence of difficult or breech delivery in birth history of our cases.
The sternomastoid tumor was presented in 58.5% of the patients and others had varying degrees of diffuse fibrosis. The majority of tumors presented before the age of 1 month. The period of conservative treatment ranged from 1 to 7 months; the
average
period was 2¾ months. Immediate results of conservative treatment which consisted of passive stretching of the sternomastoid muscle, massage, and ultrasound therapy were satisfactory in 90.2% of patients. Four of sixteen patients who showed
unsatisfactory results later had open tenotomy.
The cosmetic and functional results at follow-up available in eighty six were satisfactory in 95.3% of patients. Facial asymmetry was recovered in twenty eight after conservative treatment and at follow-up, additional five including two
surgically
treated patients showed recovery of facial asymmetry. The patients who were under the age of 3 months, who had a sternomastoid tumor and who were treated early after diagnosis required shorter duration of treatment and showed higher cure rate
than
the
others.
Based on our study, we advocate conservative treatment in children with congenital muscular torticollis during the first year of life. It yielded excellent results in the majority of patients and follow-up study indicated that congenital muscular
torticollis rarely required surgical treatment. In general, respond to conservative treatment, and it may be delayed until the age one.
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