Congenital muscular torticollis and sternomastoid tumor: results of nonoperative treatment.

BACKGROUND

Congenital muscular torticollis (CMT) and sternocleidomastoid tumor of infancy remains to be one of the mysteries of pediatric surgery. Its cause is still debated and its management is controversial.

METHODS

Fifty-seven infants and children treated consecutively for sternomastoid tumors and CMT over a 5-year period (1992 to 1997) at the Pediatric Surgery Clinic of Social Security Council Ankara Children's Hospital are reviewed. The obstetric history was recorded in 48 patients. A lump in the neck, head tilt, plagiocephaly, and facial asymmetry were reasons for refferal correlating with the age of admission. Under 18 months of age passive and active stretching exercises (PSE and ASE) were initiated in all of the cases.

RESULTS

In 28 children under the age of 3 months the outcome was excellent with none needing surgery. Successively 25% of the 3- to 6-month-old infants, 70% of the 6- to 18-month-old children, and 100% of all the older children required surgery. Spontaneous normal vaginal delivery was recorded in 23 of 48 (48%) cases, whereas vaginal vacuum extraction in four cases, vaginal forceps in six, vaginal as breech in two, and caesarean section in 11 was noted.

CONCLUSIONS

It was concluded that PSE and ASE are highly effective for the treatment of congenital muscular torticollis. The success rate of conservative treatment is primarily dependent on the patients' age at the initiation of exercises. The hypothesis of injury through the birth canal and intrauterine malposition are valid only in 12 (25%) and 13 (27%) of cases, respectively. Therefore, it is difficult to attribute as an etiologic factor.