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Clinical features of congenital muscular torticollis

Korean Journal of Pediatrics 2007;50(3):241-247.
Published online March 15, 2007.
Clinical features of congenital muscular torticollis
Ji Eun Jun, Hye Kyeong Ryu, Jae Won Shim, Jung Yeon Shim, Hye Lim Jung, Moon Soo Park, Deok-Soo Kim
Department of Pediatrics, Kangbuk Samsung Hospital, School of Medicine Sungkyunkwan University, Seoul, Kore
선천성 근성 사경의 임상적 특징
전지은, 류혜경, 심재원, 심정연, 정혜림, 박문수, 김덕수
성균관대학교 의과대학 강북삼성병원 소아과학교실
Correspondence: 
Deok-Soo Kim, Email: dskim2@skku.edu
Abstract
Purpose
: Congenital muscular torticollis (CMT) is a common and benign congenital disorder of the musculoskeletal system in neonates and infants. The pathophysiology is that the sternocleidomastoid muscle (SCM) is shortened on the involved side by fibrosis, leading to ipsilateral tilt and contralateral rotation of the face and chin. In this study, we investigated the clinical features of CMT, the role of ultrasonography (USG) in prediction of prognoses and the clinical significance of early detection and treatment.
Methods
: Forty seven patients (M:F=31:16) were diagnosed as a CMT between March 2003 and May 2006. We reviewed age at diagnosis, physical findings, USG findings, treatment and therapeutic outcome from their medical records.
Results
: The median age at diagnosis was 90 days (18 days-9 years, 7 months) and the right side of neck was affected in more patients (right : left=26:21). Of 24 patients with a palpable neck mass, 21 had USG; 19 cases showed sternocleidomastoid tumor (SMT). In cases with no neck mass, USG was performed in 11 patients; seven had postural torticollis (POST), three had SMT and one had muscular torticollis (MT). Among 40 patients with follow-up, 36 had total resolution. There was negative correlation between the age at diagnosis and the recovery time, whereas the final outcome was not correlated with USG findings. However, the patients without positive findings in USG had earlier resolution (1 month vs 2.6 months, P=0.0008). The patients with SMT had earlier diagnosis and excellent outcomes. The patients with MT were delayed to diagnosis and had the longest time to resolve. Lastly, the patients with POST had delayed diagnoses, but they had excellent outcomes.
Conclusion
: Since the patients with delayed diagnoses, in despite of benign courses, may take a long time to resolve and rarely need surgical treatment, it is important to diagnose and treat early. This study showed that USG findings of the SCM may be used as predictive factors.
Key Words: Torticollis , Ultrasonography , Therapy , Prognosis


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