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Surgical Management of Congenital Muscular Torticollis in a Child Using Z-plasty: A Case Report and Literature Review
Abdelouahid Taleuan1, Mohammed ElAmine Squalli Houssaini2, Adnane Lakhal2
1Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Pharmacy, Al Amir Sultan Hospital, Errachidia, MAR.
Insights
Congenital muscular torticollis (CMT) in older children can be effectively treated with surgery when conservative methods fail. Surgical release of the sternocleidomastoid muscle (SCM) offers significant functional and cosmetic improvements for neglected cases.
Area of Science:
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Congenital muscular torticollis (CMT) involves sternocleidomastoid muscle (SCM) shortening, causing head tilt and facial rotation.
- While often resolving with physiotherapy in infants, delayed diagnosis in older children leads to limited conservative treatment outcomes.
- Neglected CMT cases are common in developing regions, presenting challenges for management.
Abstract:
Congenital muscular torticollis (CMT) is characterized by unilateral shortening of the sternocleidomastoid muscle (SCM), producing ipsilateral head tilt and contralateral rotation of the face and chin. It usually manifests during infancy and responds favorably to conservative treatment based on physiotherapy; spontaneous resolution is expected in the majority of cases. However, when diagnosis is delayed and patients present at a later age, conservative approaches tend to yield limited outcomes, neglected presentations remain prevalent in developing countries such as Morocco, where patients often present beyond the optimal age for conservative management. We report the case of an 11-year-old female patient with CMT, who was successfully managed through unipolar SCM release combined with Z-plasty lengthening, yielding significant functional improvement and a satisfactory cosmetic outcome. This case underscores that surgical correction remains a viable and effective therapeutic option in older children with neglected CMT, even when conservative management has failed and the deformity has become chronic.
