Follow-up Of Surgical Treatment For Congenital Muscular Torticollis

Objective: To follow-up the surgical treatment for congenital muscular torticollis(CMT) for more than two years and to compare the curative effect in different groupsso as to find out the influence factors on the optimal timing of surgery for the disease.Methods: One hundren and twenty patients with congenital muscular torticollis, ageranged from3to142months (average25.1),underwent surgical releases of thecontractive bands and were followed-up for more than two years (ranged from2to12.5years with average4.9years) in Shenzhen Children’s Hospital. Over all of thepatients were grouped by age, preoperative physical therapy and surgical procedures.According to the characteristics of child growth and development, patients weredivided to three age groups, i.e. GroupⅠwith age1year or less, GroupⅡ1to3yearsold and GroupⅢ more than3years. According to whether patient treated by physicaltherapy before operation, the patient were divided to physical therapy group andnon-physical therapy group. According to surgical procedure, the patients weredivided to unipolar resection group and bipolar resection group. Accoding to overalloutcome, patient were divided to excellent group and non-excellent group. Theoverall clinical outcome were assessed by using the Cheng’s score table, in whichrotational defcits, lateral bending defcits, craniofacial asymmetry, scar, band,subjective assessment, and head tilt were included. The differences between each twogroups were evaluated with chi-square and analysis of variance. The value of P <0.05was considered statistically significant. Measurement in each side of face and headwas carried out and relationships in each parameters were studied.Results: statistical difference between excellent and non-excellent group were foundin production style, preoperative physical therapy, age at operation. Logisticregression analysis showed that age at operation was statistically related to overalloutcome(P＜0.05）. The risk fact was increasing with age, even to as high as2.285-fold. Spearman correlation analysis showed that overoutcome was decreasedwith the age, the old the patient’s age, the worse the overall outcome. According to Overall scores for overall outcome，there were79cases with excellent (65.8%),37with good(30.9%),1with fair(0.8%) and3with poor(2.5%). The excellent and goodresults were as high as96.7%. No significant difference of scar scoring were found inthe age groups(P>0.05). However, statistical significant difference of head tilt,rotational defcits, lateral bending defcits, band and overall clinical outcome werefound between age groupⅠand Ⅲ and between age group Ⅱ and Ⅲ. The resultsindicates that more excellent outcome cases were found in age groupⅠ and Ⅱ. Thecraniofacial asymmetry appearance was cosmetically improved more well in agegroup Ⅰ than in groupⅡ and Ⅲ(P＜0.05). For the subjective assessment bydoctors, the more excellent cases were found in groupⅠthan in other two groups. Inaddition, more excellent cases were found in physical therapy group than innon-physical therapy group and in bipolar resection group than in unipolar resectiongroup respectively.Conclusion: Age at the operation is key fact which is related to overall outcome.The surgical treatment for patient with congenital muscular torticollis are moreefficacious if the age is under3years old expecially under1year. For the patients ageunder one year, surgery should be considered if the manual stretching treatment forsix months is poor. If the surgical treatment is carried out for patients within one yearold, the skull deformity cure well in the follow-up.