Magnetic Resonance Imaging as a Determinant for Surgical Release of Congenital Muscular Torticollis: Correlation with the Histopathologic Findings

Abstract

Objective (1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT. Method The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass. Results All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized. Conclusion The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

Effectiveness of Surgical Treatment for Neglected Congenital Muscular Torticollis

“…4 However, approximately 10 to 20 percent of patients with congenital muscular torticollis have a large amount of fibrosis composed of dense connective tissue within the sternocleidomastoid muscle. 5 This subgroup of individuals with congenital muscular torticollis does not respond well to stretching exercises. 5 Therefore, surgical treatment is needed for this subgroup of patients to minimize the secondary musculoskeletal complications of congenital muscular torticollis.…”

“…5 This subgroup of individuals with congenital muscular torticollis does not respond well to stretching exercises. 5 Therefore, surgical treatment is needed for this subgroup of patients to minimize the secondary musculoskeletal complications of congenital muscular torticollis. 3 The ideal age for surgical treatment of congenital muscular torticollis is younger than 5 years.…”

Congenital Muscular Torticollis Concurrent With Sagittal Synostosis: A Case Report

“…For establishing the diagnosis of CMT, ultrasonography or MRI has been used to detect the characteristic fibrotic lesion in the SCM [4]. However, in these two case reports, the patients did not show fibrosis or thickening of the SCM.…”

Congenital Muscular Torticollis: An Overview

“…In a recent study MRI findings have been found to be correlated with histopathological findings [19].…”