Sternocleidomastoid surgical release for congenital torticollis: indications, recovery and physical therapy. Dr. Priano, Milan.
Surgery when physical therapy is insufficient
Learn about this condition →Procedure involving partial or complete sectioning of sternocleidomastoid muscle insertions to restore neck mobility.
Persistent torticollis after 12 months of intensive physical therapy, with residual rotation/tilt >15-20°, or progressive facial asymmetry.
Minerva brace or similar for 3-4 weeks. Intensive post-operative physical therapy for 3-6 months.
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.
Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.
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 the prescribed programme. Facial asymmetry may improve with growth, but complete correction is not guaranteed, particularly after later treatment.
Progressive return after recovery of movement and function and the surgeon’s clearance. Sport is chosen according to age and preference; swimming has no privileged indication for correcting asymmetry.
Follow-ups at 2 weeks, 1 month, 3 months, 6 months, 1 year. Then during growth to monitor facial asymmetry.
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.
Causes, diagnosis, conservative options and when surgery is considered.
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