Congenital muscular torticollis: current concepts and review of treatment.
OBJECTIVE
The purpose of this review is to better understand the spectrum of disease in torticollis, which is the third most common pediatric orthopaedic diagnosis in childhood. Besides the benign muscular tightness of the sternocleidomastoid muscle leading to the classic head position, the differential diagnosis of the wry neck include sequelae to inflammatory, ocular, neurologic or orthopedic diseases. Patients present with a stiff and tilted neck, and therefore require a thorough and systematic work-up, including a complete physical and neurologic examination and cervical spine radiographs.


RESULTS
Recent findings show that magnetic resonance imaging of the brain and neck is no longer considered cost-effective, or necessary, in congenital muscular torticollis. Observation and physical therapy, with or without bracing, is usually an effective treatment in most cases, especially if instituted within the first year of life. Botox has recently been shown to be an effective intermediate method of treatment for more resistant cases of congenital muscular torticollis. In those presenting after the age of 1 year, there is an increased rate of sternocleidomastoid muscle lengthening. The lengthening may improve the range of motion, but not necessarily the plagiocephaly, facial asymmetry, or cranial molding.


CONCLUSIONS
It is important to differentiate muscular from nonmuscular torticollis. Congenital muscular torticollis is benign; missing a case of nonmuscular torticollis could be potentially life threatening.
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. twee.do@cchmc.org
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D000465:Algorithms; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009465:Neuromuscular Agents / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D014103:Torticollis / Q000151:congenital / Q000175:diagnosis / Q000628:therapy
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A