Congenital Muscular Torticollis: A Chapter that Led to the Establishment of the Specialty of Paediatric Orthopaedics

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.