Surgical correction of muscular torticollis in older children.

BACKGROUND

Children with muscular torticollis treated before the age of 1 year respond well to conservative treatment. Surgical correction is indicated only in resistant cases. Nevertheless, there is still controversy about the results and the type of operation in the management of neglected older children.

METHODS

Seventeen patients, at a mean age of 9 years and 5 months, with muscular torticollis were surgically treated between 1986 to 1991. The average follow-up period was 3 years and 4 months. months. Combined approach with open tenotomy at mastoid and clavicular level was the choice of procedure. The outcome for these older children and young adults were evaluated with function and cosmesis.

RESULTS

Our results showed that the best results can be expected in children before 12 years of age. Late releases give acceptable results, although facial asymmetry and some residual upper dorsal scoliosis remain. Adequate surgical release and intensive postoperative physical therapy are the keystones to a good result.

CONCLUSIONS

Surgical correction of muscular torticollis in the older children is of benefit for functional and cosmetic recovery, but facial asymmetry is irreversible after 12 years of age.