Endoscopic release of congenital muscular torticollis in children via a sub-platysmal approach: a retrospective study of 44 cases

Background Congenital muscular torticollis (CMT) is a common pediatric musculoskeletal condition resulting from unilateral contracture of the sternocleidomastoid muscle. When conservative treatment fails, surgical intervention is required. Traditional open approaches leave visible cervical scars, prompting the need for minimally invasive alternatives. This study evaluates the clinical outcomes of an innovative endoscopic sub-platysmal release technique for CMT in children. Methods We retrospectively analyzed pediatric patients (<10 years) with CMT who underwent endoscopic release via a sub-platysmal approach under general anesthesia after failed at least 6 months of conservative therapy. The procedure utilized a 2.7-mm endoscope and radiofrequency ablation with gravity-fed hemostatic irrigation. Outcomes were assessed using the Cheng and Tang scoring system, including neck rotation deficiency, lateral bending deficiency, craniofacial asymmetry, and head tilt. Operative time, blood loss, and complications were recorded. Minimum follow-up was 30 months. Results A total of 44 patients (28 males, 16 females; mean age 3.88 ± 2.15 years) operated between January 2019 and December 2023 were analyzed. The cohort had a mean follow-up of 49.3 ± 8.2 months. Mean operative time was 35.2 ± 6.4 min, and mean blood loss was 4.5 ± 1.2 mL. At final follow-up, the median neck rotation deficiency significantly improved from 26.5° (IQR, 23.1°−29.4°) preoperatively to 3.0° (IQR, 2.5°−4.1°) ( P < 0.001), and lateral bending deficiency improved from 18.2° (IQR, 15.8°−20.5°) to 2.5° (IQR, 2.0°−3.3°) ( P < 0.001). According to Cheng and Tang scoring, 42 patients (95.4%) achieved excellent or good outcomes, with earlier intervention demonstrating significantly higher clinical scores. No intraoperative or postoperative complications were observed. Conclusion This endoscopic sub-platysmal approach is a safe and effective minimally invasive technique for pediatric CMT, offering excellent functional recovery, minimal blood loss, superior cosmetic outcomes, and a remarkable safety profile. It represents a valuable addition to the surgical armamentarium for pediatric musculoskeletal disorders.