Abstract
1. A parallel study has been made of fifty patients presenting with a sternomastoid tumour and fifty-two patients presenting with muscular torticollis.
2. In the birth histories of both these groups there was a high incidence of breech, forceps and primiparous births. The distribution of each was strikingly similar.
3. Sternomastoid tumours were right-sided in three-quarters of all cases and in an even higher proportion of the breech births. There was twice the expected incidence of plagiocephaly. Only one in seven proceeded to muscular torticollis, but in some of the remainder minor residua could be detected.
4. Muscular torticollis presented at any age, but one-third commenced in the first year of life. Only one in five gave a history of previous sternomastoid tumour. The contracture showed a predilection for the clavicular head, and was generally associated with some degree of facial asymmetry.
5. Nine of a combined 102 cases had a first or second degree similarly affected relative.
6. It is concluded that whatever the condition in the muscle at birth, it has three inconstant and variable sequelae. The torticollis may resolve completely; it may become clinically manifest as a tumour; or it may remain clinically latent, subsequently undergoing a variable degree of cicatrisation to produce torticollis.
7. The treatment of established torticollis by open division is described and the follow-up in thirty-six cases recorded.
8. This operation can be relied on to cure the principal deformity, but is accompanied by a number of minor cosmetic defects. Of these the most striking are tight bands apparently due to anomalous reattachment of the clavicular head, and loss of the sternomastoid column of the neck.
9. The method could not be relied on to cure facial asymmetry completely, even in the early years of life. However, there was some evidence to suggest that persistence of asymmetry was allied to persistence of other residua of the torticollis, for example fascial bands.
