Congenital Muscular Torticollis
Definition
- sternomastoid on one side is fibrous & fails to elongate as the child grows resulting in progressive deformity
Aetiology
- Unknown
- ? Ischaemia
- muscle may have suffered ischaemia form a distorted position in utero
- supported by the association with breech presentation & DDH
- muscle may have suffered ischaemia form a distorted position in utero
- ? trauma
- May be due to birth trauma
Incidence
- Males > Females
- Right > Left
- Associations
- DDH & acetabular dysplasia in 10 - 20%
- may be related to intra-uterine posture with an ↑ incidence in breach deliveries & difficult labours
Clinically
'Sternomastoid tumour'
- In 20% a lump (sternomastoid 'tumour')is noticed in the first few weeks of life in the belly of the sternocleidomastoid on the side of the tilt
- Usually well defined & may involve one or both heads of the sternomastoid
- At this stage there is no deformity or loss of movement & deformity becomes apparent usually at 3 - 4 years of age
- Shortening of the muscle results in the mastoid process approximating the sternal notch (the ear becomes lower & further forward) & the entire face is tilted down on the affected side- the face is shorter on the affected side
- sternomastoid feels tight & cord like
X-Rays
- Normal
- Performed to exclude a congenital cervical abnormality
Pathology
- The "tumour" is a white glistening structure consisting of fibrous tissue which usually disapears in 2 - 6 months
Treatment
- Initial
- If a child has a sternomastoid tumour every effort should be made to prevent deformity developing
- physiotherapy, stretching & splintage
- If a child has a sternomastoid tumour every effort should be made to prevent deformity developing
- If deformity persists
- surgery at 1 - 4 years (Best time for operation is 18 months to 2 years)
- subcutaneous tenotomy (distal end) with care to avoid neurovascular structures
- open division of either the upper or lower end (recurrence rate following surgery less than 5%)
- surgery at 1 - 4 years (Best time for operation is 18 months to 2 years)
- Operative release is indicated
- if nonoperative treatment fails
- if late presentation with rigid deformity
- post op
- correction is maintained using a splint or collar worn for several months until head is held straight
Prognosis
- 5% recurrence rate
- correction before the age of 4 years the facial asymmetry can resolve
Webpage Last Modified:
18 February, 2010