A Retrospective Review: Treatment of Congenital Muscular Torticollis

Congenital muscular torticollis (CMT) is characterized by unilateral contraction of the sternocleidomastoid muscle, which causes head tilting and rotation. Treatment follows a stepwise approach, in which physical therapy (PT) serves as the first-line intervention, followed by botulinum toxin (Botox) injections for nonresponders and surgical lengthening of the sternocleidomastoid muscle in refractory cases. This study aims to evaluate the effectiveness of a stepwise treatment approach for CMT by assessing resolution rates following PT, Botox injections, and surgery.

A retrospective review was conducted on 109 patients diagnosed with CMT and treated at the Atlantic Center of Aesthetic and Reconstructive Surgery between 2016 and 2021. Data on patient demographics, onset of torticollis, treatment interventions, and resolution rates were collected. Statistical analysis assessed differences in treatment outcomes and timing of intervention.

All patients initially underwent PT, and 71% (n = 77) achieved resolution. Botox injections were administered to nonresponders to PT (29%, n = 32), resulting in successful treatment in 56% (n = 18) of cases. Patients who were unresponsive to Botox (13%, n = 14) required surgical intervention. Earlier treatment initiation was significantly associated with improved outcomes ( P < 0.00001). No major complications were reported with Botox or surgery. The average follow-up duration was the longest in the surgery group (27.2 months).

This study highlights the role of each treatment within a progressive management strategy for CMT. Both Botox and surgery are safe and effective options for cases that do not respond to PT, with surgery reserved for most refractory cases. These findings reinforce the importance of early intervention for optimizing patient outcomes.