Original articleRisk factors for intrauterine constraint are associated with ultrasonographically detected severe fibrosis in early congenital muscular torticollis
Section snippets
Materials and methods
All infants with clinically suspected CMT were seen at the torticollis clinics of Kangbuk Samsung Hospital and Cheil General Hospital & Women's Health Care Center from 2008 to 2009. Patients meeting the inclusion criteria were prospectively enrolled in this study after receiving informed consent. Inclusion criteria were as follows: (1) palpable neck mass or limitation of neck motion, (2) age younger than 3 months, and (3) deficit in passive neck rotation greater than 10°. Exclusion criteria
Results
Sixty-seven infants (41 boys, 26 girls) aged 15 days to 3 months (1.4 ± 0.69 months) were included in the study. Thirty-three babies (49.3%) showed type 1, 8 (11.9%) showed type 2, and 26 (38.8%) showed type 3 fibrosis. None of the subjects were classified as type 4. Basic clinical characteristics, including mean age at presentation, birth weight, and affected side, were statistically similar among the different ultrasonographic types (Table 1). Deficit in passive neck rotation of type 3 was
Discussion
Type 3 or 4 fibrosis of the SCM has been documented as clinically more significant than other ultrasonographic types because of a higher probability of requiring a surgical procedure [10], [11], [17]. In our series, none of the subjects were classified as having type 4 fibrosis. These results are different from those reported in previous studies in which 3% [10] to 5.5% [11] of patients with CMT showed type 4 fibrosis. However, in previous studies, the age range of the subjects was very wide,
Acknowledgments
This study was supported by a grant from the South Korea Healthcare Technology R&D Project (A091156). The authors would like to thank Ms Miyeon Lee at the medical information library in Kangbuk Samsung Hospital for her contributions to statistical analysis of the current study.
References (20)
Plagiocephaly and torticollis: etiology, natural history, and helmet treatment
J Pediatr
(1981)- et al.
Ultrasonographic study of the sternocleidomastioid muscle in the management of congenital muscular torticollis
J Pediatr Surg
(1997) - et al.
Correlation of clinical and ultrasonographic features in congenital muscular torticollis
Arch Phys Med Rehabil
(1999) - et al.
Congenital muscular torticollis and sternomastoid tumor: results of nonoperative treatment
J Pediatr Surg
(1999) - et al.
The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—a study of 1,086 cases
J Pediatr Surg
(2000) - et al.
Congenital muscular torticollis: evaluation and classification
Pediatr Neurol
(2006) - et al.
Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases
Arch Phys Med Rehabil
(1987) Congenital muscular torticolli: Sequale of intrauterine or perinatal compartment syndrome
J Periatr Orthop
(1993)- et al.
Congenital muscular torticollis: a spectrum of pathology
Ann Plast Surg
(1989) - et al.
The role of congenital muscular torticollis in the development of deformational plagiocephaly
Plast Reconstr Surg
(2009)
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A rare case of 9 years congenital muscular torticollis treated with complete unipolar sternocleidomastoid release: A case report and literature review
2022, International Journal of Surgery Case ReportsCitation Excerpt :Davids et al. [12] have postulated it as sequelae of an intra-uterine or perinatal compartment syndrome. Lee et al. [13] concluded that intrauterine constraint appear to be associated with ultrasonographically detected severe fibrosis involving the entire SCM muscle in early presenting CMT. Several authors have advocated surgical treatment after the age of 1 year to allow time for possible spontaneous recovery [14–16].
A Clinical Comparative Study of Ultrasound-Normal Versus Ultrasound-Abnormal Congenital Muscular Torticollis
2016, PM and RCitation Excerpt :It is well known that clinical diagnosis group, initial limitation of passive neck motion, and age at presentation are the most important predictors of the outcome of physiotherapy [7]; however, the clinical diagnosis is not always accurate. Thus, high-resolution ultrasonography (US) increasingly has received attention because of its diagnostic abilities to demonstrate a tumor or fibrotic lesion in the SCM [10-14]. In terms of CMT with abnormal US findings, several studies have been conducted on the relationship between clinical features of CMT and relevant US abnormalities, which have found a close association of the severity of abnormal US findings with treatment course or prognosis [13-17].
Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: A prospective study
2011, Journal of Pediatric SurgeryCitation Excerpt :Success rate and duration of conservative treatment at the end point were used as the outcome dependent variable. Ultrasonographic classification was performed using the criteria reported in our previous study [19], which was modified from that of Hsu et al [8] and Tang et al [9] in consensus by 1 radiologist and 1 physiatrist experienced in the examination of CMT. Criteria were defined according to the severity of fibrosis on US as follows: (1) type 1 had a localized well-defined heteroechoic mass in the involved SCM muscle, (2) type 2 represented diffuse hyperechogenecity along the entire muscle with hypoechogenic background muscle, (3) type 3 had diffuse hyperechogenecity along the entire muscle with almost no hypoechoic background, and (4) type 4 had a hyperechogenic band in the entire involved muscle.
Congenital Muscular Torticollis
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