True about congenital torticollis are all except? (AIIMS May 2010)
|A||Always caused by breech|
|B||Spontaneous resolution in most cases|
|C||Without treatment it can lead to plagiocephaly|
|D||Palpable Sternocleidomastoid tumor|
Always caused by breech
1. Injury to the sternocleidomastoid muscle may occur, particularly during a breech delivery.
2. There may be a tear of the muscle or the fascial sheath, leading to a hematoma and gradual cicatricial contraction. As the neck lengthens in the process of normal growth, the head is gradually turned toward the side of the injury a condition known as torticollis.
3. This occurs because the damaged muscle is less elastic and does not elongate at the same rate as its normal contralateral counterpart.
4. Lateral hyperextension sufficient to rupture the sternocleidomastoid may occur as the after coming head passes over the sacral promontory.
5. It represents the most common neck mass of the immediate perinatal period, within the first 2 months of life.
6. The term tumor is a misnomer because most commonly it is congenital fibrosis within the muscle. The etiology remains unclear, with the most likely cause being peripartum injury.
7. Sternocleidomastoid tumor of infancy (SCTI) has a slight male prevalence and occurs more often on the right and with breech presentations. SCTIs are typically a firm, painless mass with fusiform shape, approximately 1-3 cm in length. They are most often located in the inferior to the middle third of the sternocleidomastoid muscle, affecting the sternal or clavicular heads equally.
8. Diagnosis is based on CT scanning and ultrasound confirmation. Open biopsy is reserved for cases that do not resolve.
9. The natural course of the disease is a peak in growth for approximately 8 weeks, with complete resolution by 6 months.
10. Physiotherapy is recommended to achieve full range of motion. Some patients have small areas of residual fibrosis.
11. Surgery is reserved for patients in whom torticollis is present for more than one year, those in whom craniofacial asymmetry develops, and those for whom physiotherapy fails.
12. Long-term follow-up care is essential because of the possibility of recurrence or reappearance of the disease during periods of heightened growth.