Congenital Muscular Torticollis: A Chapter that Led to the Establishment of the Specialty of Paediatric Orthopaedics
Main Article Content
Abstract
Background: The importance of knowing about congenital muscular torticollis also lies in the fact that it ranks third as frequency among paediatric orthopaedic conditions, after congenital foot deformity and developmental dysplasia of the hip. The average incidence of this condition is 1.1%. As a result of spontaneous resolution and physiokinetotherapy, the cure rate also reached in our statistics to 98% when the diagnostic was established in the first days after birth and the treatment was initiated in the first days in special centres for newborns and infants. However, 9-21% of the patients had an indication for surgery after the age of 1 year.
Purpose: The article aims to elucidate some aspects regarding clinical signs and evolution, the importance of differential diagnosis, the implementation of appropriate recovery techniques in specialized centers for newborns and infants in order to improve current results and to make known the surgical technique designed by Romanian School of Paediatric Orthopaedics.
Study design: The article presents and illustrates the experience accumulated by the Romanian School of Paediatric Orthopaedics over the last 50 years, in the period 1975-2024. It integrates the study data with the experience of other clinics and authors, and it compares some debatable or controversial results.
Patient sample: This experience was analysed in multicentre studies that included 5,648 cases that were treated in all large specialty clinics using various procedures, and the essential notions of the most frequently used procedures are presented.
Method: The analysis and synthesis of data carried out in sessions and Consensus Conferences covered 5 distinct periods: 1) 1975-1980, the study of physiokinetotherapy methods and the results obtained up to the age of one year. 2) 1985-1990, types of surgical interventions performed and results. 3) 1990-2000, difficulties and causes that led to unfavourable results. 4) 2000-2005, histopathology studies on samples taken from resected sclerotic tissues. 5) 2005-2010, consensus for a surgical technique in different variants, adapted to each type of lesion. The documents were filed and submitted to the Romanian National Library.
The Romanian School of Pediatric Orthopedics, through Vereanu D., Pesamosca A., Socolescu M., Zamfir T., Goţia D.G., Aprodu G., Gavrilescu S.L., Gliga V., Ţepeneu P., Mironescu A., Tica D., Stan V. and Moldovan Z., made an important contribution the determination of a differentiated therapeutic attitude, in relation to the clinical form, extent, and age, in order to achieve a maximum beneficial effect. The Romanian School of Paediatric Orthopaedics procedure was initiated in university paediatric orthopaedic clinics and subsequently in county hospitals.
Results: When the diagnostic was established early, within the first 30 days, the treatment was limited to conservative measures, with good and excellent results. Most patients heal through spontaneous resolutions and by physiokinetotherapy in the first year of life. After the age of 1, surgical treatment is instituted both for aesthetic reasons, and to correct cervical mobility. The best results were obtained in patients operated on between 1 and 5 years of age. Most authors argue that surgical treatment after the age of 5 has a limited value, and when the surgical intervention is performed after puberty, the results are unsatisfactory and major complications may occur. Schoolchildren and adolescents submitted to surgical intervention for congenital muscular torticollis remain with craniofacial dysmorphism and limited head mobility. Of the total of 5,648 patients analyzed at Consensus Conferences during the period 1975-2024, 582 (10%) were operated on: 477 (82%) up to the age of 5 years, 86 (15%) between 5 and 18 years and in adulthood, between 18 and 40 years, 19 (3%).
Conclusion: The objective of surgical treatment is aesthetic and functional, and it aims to correct cervical mobility. The study confirms that current results can be improved and that Romanian School of Paediatric Orthopedics procedure is an effective alternative for schoolchildren, adolescents, and adults.
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References
2. Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants--a study of 1,086 cases. J Surg.2000;35:1091-1096
3. Kim MW, Kim DY, Lee DW, Ryoo DH, Kim J, Jang DH. Concurrence of Congenital Muscular Torticollis and Congenital Torticollis Due to Other Anomalies: Two Case Reports. Front Pediatr. 2021 Oct 27;9:709616. doi: 10.3389/fped.2021.709616. PMID: 34778123; PMCID: PMC8578520.
4. Agrawal D, Mohanty BB, Sarangi R, Kumar S, Mahapatra SK, Chinara PK. Study of incidence and prevalence of musculoskeletal anomalies in a tertiary care hospital of eastern India. J Clin Diagn Res. 2014;8:AC04-AC06. Doi: https://doi.org/10.7860/JCDR/2014/7882.4380
5. Vanassi BM, Parma GC, Magalhaes VS, Santos ACCD, Iser BPM. Congenital anomalies in Santa Catarina: case distribution and trends in 2010–2018.Rev Paul Pediatr.2021 ;40:e2020331. DOI: 10.1590/1984-0462/2022/40/2020331
6. Gliga V, Gozar H. Do tumors of the sternocleidomastoid muscle have diagnostic and therapeutic significance? Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Iasi 2000;12: 40-43
7. Jaber MR, Goldsmith AJ. Sternocleidomastoid tumor of infancy: two cases of an interesting entity. Int J Pediatr Otorhinolaryngol. 1999 Mar 15;47(3):269-74. doi: 10.1016/s0165-5876(98)00186-4. PMID: 10321783.
8. Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis. Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2018 Oct;30(4):240-290. doi: 10.1097/PEP.0000000000000544. PMID: 30277962; PMCID: PMC8568067.
9. Bredenkamp JK, Hoover LA, Berke GS, Shaw A. Congenital muscular torticollis. A spectrum of disease. Arch Otolaryngol Head Neck Surg. 1990 Feb;116(2):212-6. doi: 10.1001/archotol.1990.01870020088024. PMID: 2297419.
10. Chen HX, Tang SP, Gao FT, Xu JL, Jiang XP, Cao J, Fu GB, Sun K, Liu SZ, Shi W. Fibrosis, adipogenesis, and muscle atrophy in congenital muscular torticollis. Medicine (Baltimore). 2014 Nov;93(23):e138. doi: 10.1097/MD.0000000000000138. PMID: 25415668; PMCID: PMC4616345
11. Leung, A.K.C. (2009). Sternocleidomastoid Tumor of Infancy. In: Lang, F. (eds) Encyclopedia of Molecular Mechanisms of Disease. Springer 2009, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-29676-8_3349
12. Vereanu D, Socolescu M, Bîscă N . Small tumor at the tendinomuscular junction: prognostic index in the occurrence of CMT. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Iasi 1972;12:31- 37
13. Pesamosca A, Puiu St et all. Small tumor at the tendinomuscular junction: prognostic index in the occurrence of CMT. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Iasi 1972;12:6-11
14. Fenton R, Gaetani SA. A pediatric epidemic: Deformational plagiocephaly/brachycephaly and congenital muscular torticollis. February 1, 2019 Contemporary PEDS Journal Vol 36 No 2 Issue 2
15. Hwang, Lisa Ann Change-Yee, "Screening for Torticollis and Plagiocephaly: The Role of the Pediatrician" 2014. Loma Linda University Electronic Theses, Dissertations & Projects. 211.
https://scholarsrepository.llu.edu/etd/211
16. Moldovan Z, Soiu M, Trailescu M, Osakwe H. The effect of congenital muscular torticollis in children over 4 years of age who have not undergone surgery. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Constanța 2004;11:31-33
17. Burnei G, Ciobanu C, Neagoe P. Three cases of bilateral congenital muscular torticollis operated on in series. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Brașov 1999;4:12-19
18. Goția DG, Aprodu G, Gavrilescu SL. Results of physiotherapy treatment in children with congenital muscular torticollis. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Iasi 2000;12: 7-11
19. Michalska A, Śliwiński Z, Pogorzelska J et al. Congenital muscular torticollis - a proposal for treatment and physiotherapy. Med Rehabil. 2019;23(3):21-30. https://doi.org/10.5604/01.3001.0013.3728]
20. Canale ST, Griffin DW, Hubbard CN. Congenital muscular torticollis. A long-term follow-up. J Bone Joint Surg Am. 1982 Jul;64(6):810-6. PMID: 7085709
21. Sönmez K, Türkyilmaz Z, Demiroğullari B, Ozen IO, Karabulut R, Bağbanci B, Başaklar AC, Kale N. Congenital muscular torticollis in children. ORL J Otorhinolaryngol Relat Spec. 2005;67(6):344-7. doi: 10.1159/000090046. Epub 2005 Dec 1. PMID: 16327275
22. Țepeneu P, Tepeneu N Junior, Lazea St. Multicenter Study in the period 1986-1987 (Bucharest, Timisoara, Cluj, Iasi, Craiova, Constanta, Targu Mures, Brasov); Evolution of congenital muscular torticollis treated conservatively up to 1 year of age. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Timisoara 1998;12:2-11
23. Borgeat A, Blumenthal S. Chapter 25. Interscalene Brachial Plexus Block. In: Hadzic A, ed. NYSORA Textbook of Regional Anesthesia and Acute Pain Management. The McGraw-Hill Companies; 2007.
24. Banculescu (Coșofreț) M. Doctoral Thesis; Postoperative Pain Management in Pediatric Surgery. Constanta. 2011: 155-160. Ovidius University Library Constanta
25. Fettiplace MR, Bhatia A, Chen Y, Orebaugh SL, Gofeld M, Gabriel RA, Sessler DI, Lonsdale H, Bungart B, Cheng CP, Burnett GW, Han L, Wiles M, Coppens S, Joseph T, Schreiber KL, Volk T, Urman RD, Kovacheva VP, Wu CL, Mariano ER, Ip VHY. Recommendations for disclosure of artificial intelligence in scientific writing and publishing: a regional anesthesia and pain medicine modified Delphi study. Reg Anesth Pain Med. 2025 Sep 2:rapm-2025-106852. doi: 10.1136/rapm-2025-106852. Epub ahead of print. PMID: 40897450; PMCID: PMC12418700.
26. Georgescu I, Ulici A, Ghita R, Japie EM, Pandea N, Pârvan A, Burnei C, Tiripa IL, Martiniuc A, Hamei S, Draghici I. Herbert capsuloplasty and Burnei tenomyoplasty for the correction of genu flexum in cerebral palsy, arthrogryposis and posttraumatic. Chirurgia (Bucur). 2013 Nov-Dec;108(6):866-73. PMID: 24331328
27. Hussein M.A., Yun I.S., Lee D.W., Park H., Oock K.Y. Cervical spine dysmorphism in congenital muscular torticollis. J. Craniofac Surg. 2018;29:925–929. doi: 10.1097/SCS.0000000000004357.
28. Socolescu M, Ionescu I, Braha L. Excisions of sclerotic branches of the middle cervical fascia extending to the perivascular sheath: risks and benefits. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Bucharest 1991; 2:5-8
29. Burstein FD, Cohen SR. Endoscopic surgical treatment for congenital muscular torticollis. Plast Reconstr Surg. 1998;101:20–4. discussion 25-26
30. Sasaki S, Yamamoto Y, Sugihara T, et al. Endoscopic tenotomy of the sternocleidomastoid muscle: new method for surgical correction of muscular torticollis. Plast Reconstr Surg. 2000;105:1764–7.
31. Kamboh UA, Ashraf M, Zahra SG, Raza MA, Manzoor M, Mehboob M, et al. Outcome of surgical treatment for neglected congenital muscular torticollis: A series of 28 adolescent patients. Surg Neurol Int 2022;13:292.
32. Anthology by Liiceanu G. în book; 322 memorable words of Petre Țuțea.., 2nd edition; 1999: Bucharest, Humanitas Publishing Hous
33. Burnei G. Pediatric Orthopedics is Science, Art and Prediction. J Surg 2021;6:1423 Doi: 10.29011/2575-9760.001423.
34. Liiceanu G. In book; Appeal to the Liches. 2019, Bucharest, Humanitas Publishing House
35. Brusten Ioana. # White coats. People who do (us) good. Interviews with personalities from the medical world. 2021; p. 5 Bucharest: e Publishers
36. Cipola CM. The Basic Laws of Human Stupidity Bucharest; 2014: Humanitas Publishing House
37. Cunha B, Tadi P, Bragg BN. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 8, 2023. Torticollis.
38. Gundrathi J, Cunha B, Tiwari V, et al. Congenital Torticollis. [Updated 2024 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549778/
39. Kim JH, Yum TH, Shim JS. Secondary Cervicothoracic Scoliosis in Congenital Muscular Torticollis. Clin Orthop Surg. 2019 Sep;11(3):344-351. doi: 10.4055/cios. 2019.11.3.344. Epub 2019 Aug 12. PMID: 31475057; PMCID: PMC6695322
40. Lee EH, Kang YK, Bose K: Surgical correction of muscular torticollis in the older child. J Pediatr Orthop. 1986, 6 (5): 585-9.
41. Minamitani K, Inoue A, Okuno T: Results of surgical treatment of muscular torticollis for patients greater than 6 years of age. J Pediatr Orthop. 1990, 10 (6): 754-9.
42. Omidi-Kashani, F., Hasankhani, E.G., Sharifi, R. et al. Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study.BMC Musculoskelet Disord 9, 158 (2008). https://doi.org/10.1186/1471-2474-9-158
43. Mironescu R, Munteanu L. Difficulties in fully recovering head mobility in older children with Congenital Muscular Torticollis. Consensus Conference in Pediatric Orthopedics: Congenital Muscular Torticollis, Iasi 2000;12: 23-25
44. Ippolito, E., Tudisco, C. Idiopathic muscular torticollis in adults. Arch. Orth. Traum. Surg. 105, 49–54 (1986). https://doi.org/10.1007/BF00625661
45. Conventry MB, Harris LE. Congenital muscular torticollis in infancy; some observations regarding treatment. J Bone Joint Surg Am. 1959 Jul;41-A(5):815-22. PMID: 13664717.
46. Sudesh P, Bali K, Mootha AK, Dhillon MS. Results of bipolar release in the treatment of congenital muscular torticolis in patients older than 10 years of age. J Child Orthop. 2010 Jun;4(3):227-32. doi: 10.1007/s11832-010-0254-x. Epub 2010 Mar 26. PMID: 21629376; PMCID: PMC2866850.
47. Burnei G, Geanta V, Voiculescu I. A New Eclectic Open Surgical Management of Recurrent, Rezidual, or Neglected Clubfoot in Children: An update on old and new in the field. Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023. ISSN 2375-1924. Available at:
48. Jawadi HA. Clubfoot and congenital muscular torticolis prevalence in children diagnosed with developmental dysplasia of hip: review of 594 DDH patients. Pediatr Her. 2016, 6: 24
49. Burnei G. Eradicating developmental dislocation of the hip: A national program in Romania using the Graf method of ultrasound examination. Med Ultrason 2014;16: 391392
50. Von Heideken J, Green DW, Burke SW, et al. The relationship between developmental dysplasia of the hip and congenital muscular torticollis. J Pediatr Orthop. 2006;26:805–808.
51. Park HK, Kang EY, Lee SH, et al. The utility of ultrasonography for the diagnosis of developmental dysplasia of hip joint in congenital muscular torticollis. Ann Rehab Med. 2013;37:26–32.