The majority of children with CMT have complete resolution with conservative management including physiotherapy and a home programme.[2]Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am. 2001;83-A(5):679-87.
http://www.ncbi.nlm.nih.gov/pubmed/11379737?tool=bestpractice.com
[10]Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987 Apr;68(4):222-5.
http://www.ncbi.nlm.nih.gov/pubmed/3566514?tool=bestpractice.com
[16]Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994 Oct;74(10):921-9.
http://ptjournal.apta.org/content/74/10/921.full.pdf+html
http://www.ncbi.nlm.nih.gov/pubmed/8090843?tool=bestpractice.com
Younger age at diagnosis and less severe rotation or lateral flexion deformities have been shown to positively influence outcome and treatment duration in most studies. Results vary in studies comparing the outcomes of children with a sternocleidomastoid mass and those without.[10]Binder H, Eng GD, Gaiser JF, et al. Congenital muscular torticollis: results of conservative management with long-term follow-up in 85 cases. Arch Phys Med Rehabil. 1987 Apr;68(4):222-5.
http://www.ncbi.nlm.nih.gov/pubmed/3566514?tool=bestpractice.com
[16]Emery C. The determinants of treatment duration for congenital muscular torticollis. Phys Ther. 1994 Oct;74(10):921-9.
http://ptjournal.apta.org/content/74/10/921.full.pdf+html
http://www.ncbi.nlm.nih.gov/pubmed/8090843?tool=bestpractice.com
Even if a child requires surgery, most studies have shown a good outcome with long-term follow-up. One study of patients (age range 2 to 13 years) with CMT treated surgically showed excellent results in 88%.[40]Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200.
http://www.ncbi.nlm.nih.gov/pubmed/10335298?tool=bestpractice.com
The most important factor affecting the overall result and outcome was age at the time of operation: excellent results were obtained in all children under the age of 3 years. Endoscopic release has been shown to have a favourable long-term outcome.[40]Cheng JC, Tang SP. Outcome of surgical treatment of congenital muscular torticollis. Clin Orthop Relat Res. 1999 May;(362):190-200.
http://www.ncbi.nlm.nih.gov/pubmed/10335298?tool=bestpractice.com
[41]Burstein FD. Long-term experience with endoscopic surgical treatment for congenital muscular torticollis in infants and children: a review of 85 cases. Plast Reconstr Surg. 2004 Aug;114(2):491-3.
http://www.ncbi.nlm.nih.gov/pubmed/15277820?tool=bestpractice.com
Long-term development is not affected; however, children who do not experience frequent prone positioning while awake may have delayed acquisition of prone skills such as crawling.[43]Tessmer A, Mooney P, Pelland L. A developmental perspective on congenital muscular torticollis: a critical appraisal of the evidence. Pediatr Phys Ther. 2010;22:378-383.
http://www.ncbi.nlm.nih.gov/pubmed/21068637?tool=bestpractice.com
Plagiocephaly alone is not a predictor of developmental delay in infants with plagiocephaly and torticollis. In very young infants (i.e., average age 22 weeks), developmental delay appears to be related to sleep position, muscle tone, activity level, male sex, and neck dysfunction.[44]Hutchison BL, Stewart AW, Mitchell EA. Characteristics, head shape measurements and developmental delay in 287 consecutive infants attending a plagiocephaly clinic. Acta Paediatr. 2009 Sep;98(9):1494-9.
http://www.ncbi.nlm.nih.gov/pubmed/19548915?tool=bestpractice.com