Congenital muscular torticollis. A long-term follow-up.

Fifty-seven patients with congenital muscular torticollis who were treated between 1941 and 1977 were evaluated after an average follow-up of 18.9 years. We found that if congenital muscular torticollis persisted beyond the age of one year, it did not resolve spontaneously. Children with torticollis who were treated during the first year of life had better results than those treated later, and an exercise program was more likely to be successful when the restriction of motion was less than 30 degrees and there was no facial asymmetry or the facial asymmetry was noted only by the examiner. Non-operative therapy after the age of one year was rarely successful. Regardless of the type of treatment, established facial asymmetry and limitation of motion of more than 30 degrees at the beginning of treatment usually precluded a good result. While these fifty-seven patients had little functional abnormality at follow-up (some of those with a persistent head tilt had mild, asymptomatic compensatory scoliosis), noticeable cosmetic deformity was present in approximately 31 per cent of the patients.