Fig. 8.1
Neck ultrasound showing left sternomastoid tumor
MRI may be useful in patients with nonmuscular causes of torticollis.
Histopathologic findings include:
Fibrous replacement of skeletal muscle fibers that undergo atrophy.
The degree of fibrosis and its extent or distribution may vary.
Even in neonates, the fibrous tissue is mature.
This finding indicates that the disease began before birth.
Management
Medical management of torticollis involves conservative treatment.
Sternocleidomastoid fibrosis spontaneously resolves in the vast majority of infants (success rate of 80–95 %).
The management for torticollis is primarily nonoperative, generally consisting of physiotherapy.
Surgical management of congenital muscular torticollis is generally avoided until the child is aged at least 1 year.
Only about 4–5 % of patients are surgically treated, generally after the age of 1 year.
Indications for surgical management include:
Persistent sternocleidomastoid contracture limiting head movement
Persistent sternocleidomastoid contracture accompanied by progressive facial hemihypoplasia
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