Orthotic Treatment for Muscular Torticollis

S. LANGO, M.D. E. P. SCHWENTKER, M.D. JAMES SWEIGART, C.P.O.


Congenital muscular contracture of the sternocleidomastoid muscle results in an asymmetrical deformity of the head and neck known as congenital muscular torticollis. In this condition the head is tilted to the side of the contracted muscle, and the chin is rotated to the opposite side (Figure 1 and Figure 2 ). The treatment for torticollis may range from simple exercising to complete surgical release of the sternocleidomastoid muscle. Immobilization of the head and neck in a corrected or overcorrected position is occasionally required, most frequently as part of the postoperative management. Immobilization may be provided with a cumbersome plaster cast or with an orthosis. The Buckminster-Brown orthosis used in the past was bulky and difficult to fit. We constructed an Orthoplast orthosis which is light and hygienic and which can be adjusted to individual needs (Figure 3 and Figure 4 ).

The prescribed orthosis was constructed of Orthoplast directly on the patient. A cotton stockinette of appropriate size was fitted over his neck, head, and shoulder areas, with holes cut for his eyes and nose. A horseshoe-shaped piece of 3-mm (1/8-in.) perforated Orthoplast was cut with the aid of a paper pattern and then soaked in l60-degree (F) water until it was pliable enough to be molded directly on the patient. Appropriately shaped lateral head-holding pieces were added to the horseshoe-shaped Orthoplast shoulder girdle while the head was held firmly in the corrected position. Reinforcing ribs were added to the orthosis to give the needed rigidity. Velcro closures were added to the posterior opening in the Orthoplast shoulder girdle and also posteriorly to the lateral head pieces.

All reinforcing was done with clean, dry-heated Orthoplast that was previously washed with ethylene-trichloride. This material was then firmly adhered to the partially completed orthosis.

References:
1. Chandler, F. A., Muscular torticollis. J Bone Joint Surg, 30-A:566, 1948.

2. Coventry, M. D., and L. Harris, Congenital muscular torticollis in infancy. Some observations regarding treatment. J Bone Joint Surg, 41-A:815, 1959.

3. Tachdjian, M. 0., Pediatric Orthopedics. W. B. Saunders Company, Philadelphia, 1972, 65.