Congenital muscular torticollis and sternomastoid tumor: Results of nonoperative treatment

Background: Congenital muscular torticollis (CMT) and sternocleidomastoid t umor of infancy remains to be one of the mysteries of pediatric surgery. It s cause is still debated and its management is controversial. Methods: Fifty-seven infants and children treated consecutively for sternom astoid 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 re viewed. The obstetric history was recorded in 48 patients. A lump in the ne ck, head tilt, plagiocephaly, and facial asymmetry were reasons for reffera l 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 cas es. 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 infan ts, 70% of the 6- to 18-month-old children, and 100% of all the older child ren required surgery. Spontaneous normal vaginal delivery was recorded in 2 3 of 48 (48%) cases, whereas vaginal vacuum extraction in four cases, vagin al forceps in six, vaginal as breech in two, and caesarean section in 11 wa s noted. Conclusions: It was concluded that PSE and ASE are highly effective for the treatment of congenital muscular torticollis. The success rate of conserva tive treatment is primarily dependent on the patients' age at the initiatio n of exercises. The hypothesis of injury through the birth canal and intrau terine malposition are valid only in 12 (25%) and 13 (27%) of cases, respec tively. Therefore, it is difficult to attribute as an etiologic factor. Cop yright (C) 1999 by W.B. Saunders Company.