A Comparison of Outcome of Age at Time Surgery between Younger and Older than 8 Years Old in Children with Congenital Muscular Torticollis

Objective: Comparing results between surgical techniques and age at the time of surgery, and the effectiveness of surgical release unipolar or bipolar or both the sternocleidomastoid muscle for congenital muscular torticollis. Methods: This study was a retrospective study of 44 cases with sternocleidomastoid muscle. Children had operated release at mean age: 6.2 years old, at Pediatric Orthopaedic Department of National Hospital for Padiatrics between October 2006 and December 2015. Preoperative assessment included the age of child at presentation, any previous history of swelling in the neck in infancy. The degree of neck tilt and range of motion of the neck, flexion and limitation of rotation were recorded. The ultrasound, measure cervico-mandibular angle (CMA). Children had performed operation by Unipolar or Bipolar release. Operative results were according to assess by the score of Cheng et al. Results: The patients were divided into two Variants. Variant 1 (patients Younger than 8 Years) had 33 Patients and Variant 2 (patients Older than 8 Years) had 11 patients. Sex: Female: 18, Male 26; Mean age: 6.2 years old; Affect side: Right: 31, Left: 13; Operative Methods: Unipolar: 33, Bipolar: 11; Follow-up: 55.0 months (24-81). Improvement of limitation of Lateral Bending in Variant 1/Variant 2: 95.2%/63.2%; Improvement of Limitation of Rotation in Variant 1/Variant 2: 63.9%/52.7%; Improvement of Angle of Head Tilt in Variant 1/Variant 2: 86.6%/66.3%. Accepted result (Excellent Good): 30/33 (90.9% in Variant 1, 8/11 (72.7%) in Variant 2. Conclusion: The diagnostic and evaluation of CMT requires a systematic team approach with members from fields of radiology, physiotherapy, craniofacial surgery, orthopaedics, neurosurgery and ophthalmology. The patients should be performed surgery for neck muscle release only if torticollis persists after the age of one year. The rehabilitation should be performed soon after surgery.