Delayed presentation of muscular torticollis- an observational study

Torticollis is a common disorder that may occur in newborns to adults. The most common cause of torticollis is the tightness and shortening of one sternomastoid muscle, also known as congenital muscular torticollis (CMT). This paper presents our experience in surgical management of torticollis, where secondary effects were observed.

This 10-year retrospective observational study included all patients with CMT. The demographic and clinical details of the patients were recorded. The treatment included surgical division of both lower heads of the sternocleidomastoid. The patients were followed for a year to monitor for any recurrence and assess compliance with exercises.

All patients (n = 13) had a fibrotic sternomastoid muscle on the affected side. The mean age was 4.65 years. Ten patients had a right torticollis (male to female: 7:6). Plagiocephaly and hemifacial hypoplasia were present in all patients. Compensatory scoliosis was noted in nine patients. There was no intraoperative or postoperative complication. In the follow-up, all patients had responded to the surgical intervention and physiotherapy. Hemifacial hypoplasia was evident at the 1-year follow-up in all patients.

The delayed presentation of CMT can be a cause of concern for attendants due to the resultant cosmetic and functional problem. Proper clinical diagnosis is imperative. Surgical intervention in form of complete division of the affected sternomastoid muscle is of utmost importance. Parental counselling about follow-up and physiotherapy is needed for desired outcome.