Surgical Treatment of Severe Neglected Congenital Muscular Torticollis in an 8‐Year‐Old Child: A Case Report

Introduction and Importance Congenital muscular torticollis (CMT) represents the third most common musculoskeletal deformity encountered in pediatric practice, characterized by unilateral shortening of the sternocleidomastoid (SCM) muscle. Neglected, untreated cases are rare. The objective was to assess the surgical outcome following complete bipolar tenotomy for the management of severe, neglected left‐sided CMT in an 8‐year‐old girl. Case Presentation An 8‐year‐old girl presented with marked facial asymmetry with left hemifacial hypoplasia, restricted cervical range of motion, and a tense, contracted left SCM. The patient underwent a complete bipolar tenotomy of the SCM. Intraoperatively, correction of the cervicomandibular angle (CMA) was achieved, with a reduction from 38° preoperatively to 8.9° postoperatively. The postoperative protocol included the use of a cervical collar and 6 weeks of intensive physiotherapy. Five years postoperatively, she maintained a neutral head position with full cervical motion and no recurrence. Clinical Discussion Around 10%–20% of cases with CMT remain unresponsive to conservative approaches and require surgical intervention. Because of concerns regarding residual deformity and scarring, surgical correction of CMT is generally recommended between 1 and 5 years of age. However, evidence suggests that even patients treated later, like in our case at age eight, experience significant improvement in appearance, function, and pain. Conclusion Complete bipolar tenotomy represents a safe and effective surgical technique for the management of severe, neglected CMT, leading to significant functional and cosmetic improvement even beyond the traditionally recommended age for intervention.