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Botulinum Toxin Type A as an Alternative to Surgery for the Treatment of Persistent Congenital Muscular Torticollis
Brian N. Boland, MD1, Meenakshi Rajan, MD1, Jennifer Harris, BS, MS2, Eric J. Stelnicki, MD3.
1Cleveland Clinic Florida, Weston, FL, USA, 2Dalhousie University, Halifax, NS, Canada, 3Joe Dimaggio Children's Hospital, Hollywood, FL, USA.

Background:
Congenital muscular torticollis (CMT) is caused by shortening of the sternocleidomastoid (SCM) muscle and may lead to limitation of neck movement, head tilt, and craniofacial deformity. This condition can be treated by conservative management with physical therapy and a soft cervical collar. Patients who fail conservative management are often offered surgical lengthening of the SCM. In this study, we propose that the use of Botox injections for patients with persistent torticollis refractory to conservative therapy may lead to resolution of symptoms and avoidance of surgery.
Methods:
A six-year retrospective chart review of pediatric patients treated for CMT by a single surgeon was performed. Patients were identified by diagnosis and procedure codes. Data collected included age, gender, treatment type, number of treatments, laterality, time to follow-up, success of treatment, and complications. Treatment success was defined as resolving head tilt, a flaccid SCM, and family satisfaction.
Results:
161 patients received Botox treatments (100u IM into affected SCM) for persistent torticollis unresponsive to conservative management. Average age was 2 years.
66.5% of patients (107) with persistent torticollis were successfully treated with Botox treatment alone. The remaining 33.5% (54) underwent surgical SCM lengthening around 2 years of age. Complications were low and included aspiration (0.9%) and injection site erythema (0.9%).
Conclusion:
In this study, 66.5% of pediatric patients with persistent torticollis refractory to conservative management were successfully treated with Botox injections alone. The use of Botox affords minimal complications and avoidance of invasive surgical approaches.


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