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Infantile torticollis

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    Does early treatment of infantile torticollis prevent established deformity needing surgery? Do all babies with a sternomastoid tumour need passive muscle stretching manoeuvres? A large series from Hong Kong (JCY Cheng and colleagues.Journal of Pediatric Surgery2000;35:1091–6) does not answer these questions but provides data about outcome.  The series included 1086 infants with torticollis (excluding acute onset torticollis, spinal anomalies, spasmodic torticollis, and torticollis secondary to neurological, ocular, or other diseases) of whom just under half had a sternomastoid tumour, about a third had a tight sternomastoid muscle but no tumour, and the remaining 20% had neither a tumour nor tightness of the muscle (postural torticollis). Hip dysplasia was found in 4% and craniofacial asymmetry in 90% of the infants.  Treatment was dictated by severity. Those with less than 10° of restriction of passive rotation (compared with the normal side) received an “active home stimulation exercise and positioning programme” (no details given). Those with greater restriction had manual stretching performed by a physiotherapist three times a week. The average duration of treatment was four months. Surgery was restricted to those with significant head tilt and restriction of rotation unresponsive to at least six months of manual stretching.  A quarter of all infants were treated at home and all did well. Of those who had manual stretching over 90% did well and 5% had surgery. None of the postural group needed surgery.  Most infants with muscular torticollis do well with conservative management. A few (4% in this series) eventually need surgery.

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