Is craniofacial asymmetry progressive in the untreated congenital muscular torticollis?

Abstract

Although craniofacial asymmetry is frequently involved in the congenital muscular torticollis (CMT) patients who require surgical release, it has not been evaluated appropriately. Therefore, little is still known concerning severity and change of craniofacial asymmetry with aging. The authors analyzed preoperative craniofacial asymmetry objectively and confirmed relationship between craniofacial asymmetry and aging in CMT patients who got surgical release.

The authors retrospectively measured preoperative craniofacial asymmetry using cranial vault asymmetry index (CVAI) and inter-commissural angle (ICA) and reviewed preoperative rotational and flexional deficit of neck movement for 123 CMT patients who underwent complete tight fibrous band release and resection at the Center for Torticollis, Ajou Medical Center from February 2007 to February 2011. The relationship between CVAI, ICA, rotational deficit, and flexional deficit, and age at operation were analyzed. Mean values of CVAI, ICA, rotational deficit, and flexional deficit were compared between the age groups, after grouping the patients by age (Age Group 1, surgically treated before the age of 1 year; Age Group 2, from 1 to 3 years; Age Group 3, from 3 to5 years; Age Group 4, from 5 to 10 years; and Age Group 5, after 10 years).

Mean age at operation was 82.5 months (range, 5-498 months). Seventy-one percent (n=87) of patients had a significant cranial asymmetry and eighty-seven percent (n=107) of patients had a significant facial asymmetry. In correlation analysis, ICA increased proportionally to age (Pearson correlation coefficient r=0.334, p=0.000), especially patients under 3 years old (r=0.42, p =0.001). CVAI was unrelated to age, rotational deficit, and flexional deficit. Rotational deficit decreased proportionally to age (r=-0.229, p=0.032). In ANOVA test, ICA and rotational deficit between the age groups were statistically significantly different (p<0.05)

In congenital muscular torticollis, facial asymmetry is progressive if the contracted SCM muscle is not released although cranial asymmetry is already determined younger than 6 months old. Early operation should be considered to prevent progression of facial asymmetry in CMT patients if they need surgical release.