Surgery: Congenital Muscular Torticollis

Sternocleidomastoid surgical release for congenital torticollis: indications, recovery and physical therapy. Dr. Priano, Milan.

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Surgery when physical therapy is insufficient

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Surgical Techniques

Sternocleidomastoid Surgical Release (Bipolar Tenotomy)

Procedure involving partial or complete sectioning of sternocleidomastoid muscle insertions to restore neck mobility.

Indication

Persistent torticollis after 12 months of intensive physical therapy, with residual rotation/tilt >15-20°, or progressive facial asymmetry.

Recovery

Minerva brace or similar for 3-4 weeks. Intensive post-operative physical therapy for 3-6 months.

Postoperative Overview

The vast majority of congenital torticollis (>90%) resolves with early physical therapy. Surgery is reserved for a minority of cases resistant to prolonged conservative treatment.

Detailed Recovery Timeline

Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).

1-2 days hospitalization. Surgery under general anesthesia. Small incisions at sternal and clavicular muscle insertion.

Weeks 1-4: Minerva brace or rigid collar. Dressing changes. Immediate start of gentle physical therapy to maintain achieved range of motion.

Weeks 4-6: Brace removal. Intensive physical therapy 2-3 times/week. Daily home stretching is essential.

Months 2-6: Continue physical therapy. Complete facial asymmetry correction (if present) takes time and continues with growth.

Return to Sport

No sport limitations once recovery complete. Swimming particularly recommended.

Follow-up Schedule

Follow-ups at 2 weeks, 1 month, 3 months, 6 months, 1 year. Then during growth to monitor facial asymmetry.

Possible Complications

Recurrence (rare with good post-operative physical therapy). Spinal accessory nerve injury (rare, careful technique). Hematoma. Facial asymmetry may improve but not completely resolve if late surgery.

For parents