Congenital muscular torticollis: observations regarding clinical findings, associated conditions, and results of treatment.

Of the 232 patients with a diagnosis of congenital muscular torticollis, more than one-half were initially revealed before 3 weeks of age. The most common presentation at the initial clinical evaluation was head tilt. A surprisingly high incidence of associated conditions including hip dysplasia and lower extremity changes was seen. As a consequence all patients with a diagnosis of congenital muscular torticollis underwent a careful clinical review and roentgenographic examination of the entire spine and hips. Good or excellent results were achieved in all children diagnosed and treated under 1 year of age utilizing conservative measures. In the older child satisfactory results were seen for the primarily cosmetic deformity when surgically approached using an open distal myectomy. There appears to be no justification for a surgical approach in the child with congenital muscular torticollis under 1 year of age.