The outcomes of congenital torticollis delayed surgery in older children: A case series

K El Bouhmadi; Y Oukessou; B Saout Arrih; Sami Rouadi; R Abada; M Mahtar

doi:10.1016/j.ijscr.2023.108144

The outcomes of congenital torticollis delayed surgery in older children: A case series

Int J Surg Case Rep. 2023 May:106:108144. doi: 10.1016/j.ijscr.2023.108144. Epub 2023 Apr 11.

Authors

K El Bouhmadi¹, Y Oukessou¹, B Saout Arrih², Sami Rouadi¹, R Abada¹, M Mahtar¹

Affiliations

¹ Otorhinolaryngology and Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University Casablanca, Morocco.
² Otorhinolaryngology and Head and Neck Surgery Department, Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University Casablanca, Morocco. Electronic address: badr.saoutarrih5@gmail.com.

Abstract

Introduction and importance: Congenital muscular torticollis is a benign affection defined as a contracture or fibrosis of the sternocleidomastoid muscle, causing ipsilateral inclination and contralateral rotation of the face and chin. The management is multidisciplinary, usually surgical and should start at very early age in infants to secure better results. Thus, the purpose of our study is to report the outcomes of delayed surgery performed in older children above 5 years old with late diagnosis.

Case presentation: We report the cases of 4 patients aged between 5 and 11 years old and followed in our department for congenital torticollis. They were all born by vaginal delivery with vacuum extraction in two cases of breech presentation. Even if the condition is present at birth, most parents were not bothered by the cervical vicious neck position of their children until a later age, delaying the diagnosis. The clinical examination found a flexed head position on the right side in all cases, with contralateral rotation. Regarding the age, we proposed surgical treatment immediately for two of them, while two were sent to our department after multiple ineffective physiotherapy sessions. The surgery consisted on right distal tenotomy and a cervical collar was prescribed next to physiotherapy. They all had successful results with correction of head position and improvement of cervical range motion.

Clinical discussion: Children treated early with active and well monitored rehabilitation, recover completely and regain normal head position and mobility rapidly. In older children, above 5 years, they are more likely to develop sequels such as asymmetry of facial movement.

Conclusion: Delayed diagnosis after the age of 5 years old still can be managed successfully with a correction of the head position and rotation motion. However, in these older children, physiotherapy alone cannot be effective and should be associated to surgery. Moreover, once the diagnosis is done, surgical treatment should be performed to avoid wasting more time.

Keywords: Congenital torticollis; Older children; Physiotherapy; Tenotomy.