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Improving Mandibular Asymmetry Associated with Congenital Muscular Torticollis using an Early Intervention Protocol
S. Alex Rottgers MD
Zoe MacIsaac MD
Regina Fenton CRNP
Susan Gaetani DPT
Lorelei Grunwaldt, MD
Anand Kumar, MD
Department of Plastic Surgery, University of Pittsburgh School of Medicine
2013-03-14
Presenter: S. Alex Rottgers
Affidavit:
The resident participated in reviewing radiographic data, data analysis, and drafting the abstract
Director Name: Joseph E. Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: Mandibular asymmetry associated with congenital muscular torticollis (CMT) has been associated with long-term facial asymmetry. Currently, no consensus exists regarding the timing and efficacy of physical therapy to treat this condition. This study aims to evaluate the improvement of facial asymmetry in CMT patients treated with early physical therapy.
Methods: A retrospective study of CMT patients treated with early physical therapy for a minimum of 6 months was performed to evaluate the degree of improvement in mandibular asymmetry. All patient underwent weekly physical therapy treatment. Pre and post-therapy CT scans were obtained to evaluate the degree of ramal height asymmetry (calculated ratio; affected/unaffected) and to rule out craniosynostosis. Patients were followed clinically and radiologically for evidence of improvement in mandibular asymmetry.
Results: Ten patients were identified. The average age at presentation was 5.5 months (3-9 months). The average duration of physical therapy was 6 months, and the average follow-up was 7.5 months (5.5-9.6). Torticollis was left sided in 60% and right side dominant in 40%. The laterality of ramal shortening correlated with the torticollis laterality in all patients. The pre therapy ramus height ratio (affected/unaffected) was 0.87, and improved to 0.93 (p=0.007). No complications occurred.
Conclusions: We have identified a unique cohort of infants with mandibular asymmetry associated with torticollis. These patients uniformly demonstrated decreased ramus height ipsilateral to the affected sternocleidomastoid muscle. Early physical therapy is associated with improved ramus symmetry.
