Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.
Head ; Humans ; Nystagmus, Congenital* ; Posture ; Strabismus ; Torticollis

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular position of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture. But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm-5.5mm and 6.5mm-7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.
Head ; Humans ; Nystagmus, Congenital* ; Posture ; Strabismus ; Torticollis

Congenital nystagmus is an involuntary, rhythmic oscillation of the eyes noted during the first months of life. The nystagmus may diminish in a particular pasition of gaze referred to as the null point or neutral zone. If the null point is located in the primary position, there is no need for a compensatory head posture, But, if a patient has an eccentric null point, torticollis occurs in which the head is rotated so that the eyes have a minimal nystagmus. This abnormal head posture can be very marked, cosmetically disturbing and disadvantageous both to the body posture and psyche. Attempts at surgical management were reported by Kestenbaum and Anderson in early 1950's. We obtained following results in 4 cases operated on utilizing similar procedures of Park's method and Dyer's principles of strabismus operations that recession of a medial rectus and lateral rectus muscle must not exceed 4.5mm - 5.5mm and 6.5mm - 7.5mm, respectively. One week after the operation, the head turn disappeared in 3 of 4 cases, and one revealed mild residual turn. Two months after the operation, 2 of 4 cases kept their head straight, and the other two showed a return of head turn in about one half amount of the preoperative condition.
Head ; Humans ; Nystagmus, Congenital* ; Posture ; Strabismus ; Torticollis

OBJECTIVE: To identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT). METHODS: This was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery. RESULTS: The median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046). CONCLUSION: We assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.
Congenital Abnormalities ; Humans ; Retrospective Studies ; Spine ; Torticollis* ; Treatment Outcome

Purpose: To propose an objective method for evaluating the craniofacial asymmetry in congenital muscular torticollis patients, and to determine the correlation between the craniofacial asymmetry and clinical parameters such as age and the limitation of neck motion. Materials and Methods: Forty eight patients with congenital muscular torticollis, who underwent cephalometry for an evaluation, were enrolled in this study. The craniofacial curvature on the coronal plane, calvarial asymmetry, and mastoid process length were analyzed on the radiograph of the cephalometry. These radiographic measurements were analyzed to determine the correlation between the craniofacial asymmetry and clinical parameters. Results: The craniofacial axis was tilted to the affected side by 5.2degrees+/-2.8degrees. The skullbase axis was tilted to the affected side by 2.6degrees+/-2.6degrees, and the mandible axis was tilted to the affected side by 1.0degrees+/-2.3degrees. The difference in the mastoid process length from the skullbase was 7.0%+/-8.5%. The calvarial width from the vertical midline was 15.4%+/-11.6% larger in the affected side. In patients older than 5 years, the mandibular tilting angle (p=0.017) and the length of the mastoid process (p=0.007) were greater than those of the younger patients. Conclusion: We proposed a new objective method for quantifying the craniofacial asymmetry in congenital muscular torticollis patients. This method confirmed the patients to have an angular deformity and asymmetry in the craniofacial bone.
Axis ; Cephalometry* ; Congenital Abnormalities ; Humans ; Mandible ; Mastoid ; Neck ; Torticollis*

Child ; Contracture ; congenital ; therapy ; Humans ; Male ; Neck Muscles ; pathology ; Torticollis ; congenital

PURPOSE: The congenital muscular torticollis is a neck deformity involving shortening of the sternocleidomastoid muscle, which is detected at birth or shortly after birth. This childhood disease is the third most common congenital musculoskeletal anomaly. The indication for surgery is a persistent head tilt with dificit of passive rotation and lateral bending of the neck and a tight band or tumor in the sternocleidomastoid muscle even after physical therapy. The purpose of this article is to report surgical outcomes with patients who had no or little response to physical therapy. METHODS: Surgery was performed on 29 patients and their average age was 4.1 years(from 6 months to 20.1 years). The unipolar open release and partial myectomy were done in 28 cases and the muscle lengthening was done in 1 case. Physical therapy was started from postoperative seventh day. Follow-up period was ranged from 2 months to 5.4 years(mean follow-up, 20.4 months). Result: There were neither rotation nor lateral bending deficit after surgical treatment. Mild head tilt was noticed in 3 cases and residual bend was observed in 4 cases. The subjective assessments of surgical results by parents were excellent. CONCLUSION: Our surgical outcome encourages the surgical treatment of congenital muscular torticollis for patients who failed to respond to physical therapy.
Congenital Abnormalities ; Follow-Up Studies ; Head ; Humans ; Muscles ; Neck ; Parents ; Parturition ; Torticollis

Our clinical observation are based on a series of 17 cases with muscular torticollis operated on since 1955 at the Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea. 1. In a series of 4 infants and 13 older children with congential torticollis, a sternocleidomastoid tumor was detected clinically in 4 cases less than 5 months of age and in 5 older patients. 2. The age at the onset of symptoms ranged from one week to 5 years, with an average duration of symptoms of nine and a ha1f years. 3. Results of surgical correction in this series were uniformly good. 4. Secondary changes in these cases of congenital torticollis were improved only when the surgical treatment was given while there was still growth potential. 5. In our series of cases, there was no congenital deformity other than torticollis. 6. On microscopic examination of the pathologic specimen, there was no evidence of hemorrhage or pyogenic infection.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Male ; Torticollis/*congenital

The analysis of 48 infants of congenital torticollis and the result of their conservative treatment are reported. The abnormalities of their neck were noticed by mothers within three months of infant life but mostly at three to four weeks. The ratio of male to female was 9:7 and incidence of right and left was 30 to 18. The mass located mostly(50%) at middle third of the sternocleidomastoid muscle belly. The prominence of incidence were noticed on the abnormality of fetal position in the uterus, mode of delivery and also on the baby of elderly primipara. About 67% of cases were breech(46%) and transverse(21%) position prenatally and 67% were delivered by forceps(41.7%), vacum and induction(12.5%each). The age of mother at delivery has close relationship between congenital torticollis with about two third of them are born of 29–34 year old mother and primipara infants were 61%. For the treatment, daily stretch exercises of affected sternocleidomastoid muscle was done by physical therapist for 20–30 times in two separate session. The effect can be noticed by the gradual correction of rotation deformity first and then the mass become soften and smaller. The next change is the correction of deviation deformity but the mass remain last. However, the mass remaining one fourth of original size was absorbed spontaneously without further treatment. The result of complete cure in ten weeks of treatment were 43(90%) out of 48 patients and the remianing five cases required for 15 weeks of treatment. In conclusion the congenital torticollis can be treated effectively by stretch exercises when it began within three months of age of the patient. A hundred per cent effect of cure may be obtained in ten weeks of treatment in case of initial treatment is begin within four weeks of age and required for 15 weeks of treatment on 4–12 weeks old infants.
Aged ; Congenital Abnormalities ; Exercise ; Female ; Humans ; Incidence ; Infant ; Male ; Mothers ; Neck ; Physical Therapists ; Torticollis ; Uterus

Child ; Humans ; Neck Muscles ; abnormalities ; Practice Guidelines as Topic ; Torticollis ; congenital ; physiopathology ; therapy