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Congenital muscular torticollis. A long-term follow-up
Insights
Congenital muscular torticollis rarely resolves after age one. Early treatment, especially before one year old, yields better outcomes for this condition, improving functional and cosmetic results.
Area of Science:
- Pediatric Orthopedics
- Rehabilitative Medicine
Background:
- Congenital muscular torticollis (CMT) is a common pediatric condition.
- Delayed diagnosis and treatment can lead to persistent deformity.
Purpose of the Study:
- To evaluate long-term outcomes of congenital muscular torticollis treatment.
- To identify factors influencing treatment success in CMT.
Main Methods:
- Retrospective evaluation of 57 patients with CMT treated between 1941 and 1977.
- Average follow-up of 18.9 years.
- Analysis of treatment timing, range of motion, and facial asymmetry.
Main Results:
- CMT persisting beyond one year did not resolve spontaneously.
- Treatment before age one yielded superior results compared to later intervention.
- Exercise therapy success correlated with <30° motion restriction and minimal facial asymmetry.
- Non-operative therapy after age one was largely ineffective.
- Significant facial asymmetry or >30° motion limitation at baseline predicted poor outcomes.
- 31% of patients had cosmetic deformities at long-term follow-up.
Conclusions:
- Early intervention is crucial for successful congenital muscular torticollis management.
- Treatment timing and initial presentation severity significantly impact long-term functional and cosmetic outcomes.
- Late-presenting or severe CMT may require more aggressive or alternative treatment strategies.
Abstract:
Fifty-seven patients with congenital muscular torticollis who were treated between 1941 and 1977 were evaluated after an average follow-up of 18.9 years. We found that if congenital muscular torticollis persisted beyond the age of one year, it did not resolve spontaneously. Children with torticollis who were treated during the first year of life had better results than those treated later, and an exercise program was more likely to be successful when the restriction of motion was less than 30 degrees and there was no facial asymmetry or the facial asymmetry was noted only by the examiner. Non-operative therapy after the age of one year was rarely successful. Regardless of the type of treatment, established facial asymmetry and limitation of motion of more than 30 degrees at the beginning of treatment usually precluded a good result. While these fifty-seven patients had little functional abnormality at follow-up (some of those with a persistent head tilt had mild, asymptomatic compensatory scoliosis), noticeable cosmetic deformity was present in approximately 31 per cent of the patients.