Neglected congenital muscular torticollis: A case report

INTRODUCTION: Congenital muscular torticollis (CMT) is identified as a thickening and/or stiffening of one side of the sternocleidomastoid muscle (SCM) due to muscle fibrosis. This condition results in shortening of SCM and constricted neck motion. CASE PRESENTATION: A four-year-old girl came with neck muscle stiffness, tilted head to the left, and chin facing to the right presenting since birth. She was diagnosed with CMT at birth. The patient was born via spontaneous vacuum-assisted vaginal delivery. At three years old, the patient did brief conservative treatment. This patient was planned for unilateral sternocleidomastoid muscle release via bipolar tenotomy. Twelve months after the surgery, there were no complications or recurrence observed. DISCUSSION: The etiology of CMT remains unknown to date, but recent studies suggest that early treatment of CMT produce better prognosis. The initial treatment for CMT is regular muscle stretching (physiotherapy), as well as education to the child's caregivers about the environmental changes and the child's posture. If the initial attempt fails, surgical intervention is needed. CONCLUSION: Early detection and early physiotherapy treatment will lead to minimize the risk of surgery. However, for cases that fail conservative therapy or neglected cases, it is recommended to carry out operative therapy to improve quality of life later.