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Idiopathic muscular torticollis in children: the Cape Town experience
1Department of Plastic and Reconstructive Surgery, Red Cross War Memorial Children's Hospital, South Africa.
Insights
Idiopathic muscular torticollis (IMT) treatment outcomes show physiotherapy benefits many patients. Surgery is effective, even when delayed, but early intervention is preferred to avoid long-term functional and cosmetic issues.
Area of Science:
- Pediatric Orthopedics
- Rehabilitative Medicine
Background:
- Idiopathic muscular torticollis (IMT) is a common pediatric condition.
- Management strategies range from physiotherapy to surgical intervention.
- Long-term outcomes and optimal timing for treatment remain areas of interest.
Purpose of the Study:
- To review long-term outcomes of surgical and conservative management for IMT.
- To evaluate the impact of treatment timing on functional and cosmetic results.
- To compare physiotherapy and surgical intervention effectiveness.
Main Methods:
- Retrospective review of 54 surgical and 134 physiotherapy cases over 23 and 5 years, respectively.
- Analysis of demographic features, treatment timing, and serial assessments.
- Long-term follow-up data for 30% of surgical cases (mean 10.5 years).
Main Results:
- Physiotherapy led to lasting benefit in 60% of cases; 36% defaulted.
- 4% of physiotherapy patients required subsequent surgery.
- Delayed surgery (up to 4-5 years) showed good long-term results if facial hemihypoplasia was absent.
- Delay beyond 6-7 years prejudiced function and cosmesis.
Conclusions:
- Physiotherapy is an effective primary treatment for many IMT cases.
- Early surgical intervention is generally preferable for optimal outcomes.
- Delayed surgery can be successful, but timing is critical to prevent irreversible facial changes.
Abstract:
54 cases of Idiopathic Muscular Torticollis (IMT) referred for surgery over a 23-year period and 134 cases referred for physiotherapy over a 5-year period have been reviewed. Long-term cosmetic and functional results for 30% of the surgical cases are presented, with a mean follow-up time of 10.5 years. Demographic features, the role of physiotherapy, the timing of surgery and serial assessment are discussed and results are compared with similar studies from other centres. Locally, of the 134 cases referred primarily for physiotherapy, 36% defaulted from treatment, 60% enjoyed lasting benefit and 4% required subsequent surgical intervention. In the surgical cases, while early surgery appears preferable, delayed operation, even up to the ages of 4 or 5 years did not seem to prejudice long-term results, providing that the advent of facial hemihypoplasia did not precede surgery. Delay beyond this point, or roughly 6 or 7 years of age, would seem to prejudice function and/or cosmesis.