Endoscopic Treatment for Muscular Torticollis

One of the most fascinating things about medicine is that even the tiniest changes can make a tremendous difference.  Nowhere is this more evident than in craniofacial plastic surgery, where, for example, removing tiny fat deposits from the eyelids during a blepharoplasty or subtracting a few millimeters from the nose during nasal reconstruction has the potential to change the entire look of the face.  During my time as director of the Center for Craniofacial Disorders at Children’s Healthcare of Atlanta, I have had the opportunity to develop a minimally-invasive treatment for a relatively common birth defect known as congenital muscular torticollis, which can achieve dramatic, life-long results with only the tiniest surgical incisions.

Affecting about one in every 9,000 infants, muscular torticollis is a congenital disorder in which the child’s head is noticeably tilted to one side.  It most commonly results when the sternocleidomastoid muscle suffers damage, either in the womb or during birth.  As the muscle heals, scar tissue forms, but this scar tissue does not grow in the same way that healthy muscle does.  Instead, this scarring causes the muscle to tighten and shorten, which in turn pulls one side of the head down towards the shoulder as the chin tilts to the opposite side.  Left untreated, the condition can cause severe limitation of neck position and the effects of gravity can lead to significant facial asymmetry.  As growth progresses, the jaw and bite may be affected, requiring complex orthodontic work or even surgical jaw realignment.  Cases that are left untreated may eventually require combined craniofacial and neurosurgical intervention to correct the head and orbital deformities that may result.

In some cases, these problems may not be immediately evident, as the trauma to the neck muscle may not affect the way the neck moves until the child is a few months old.  But regardless of when the symptoms are first observed, it is best to treat cases of muscular torticollis as early as possible, preferably starting when the infant is between nine and twelve months of age.  I recommend early treatment with vigorous physical therapy, where a physical therapist works closely with the parents to formulate a daily routine of safe stretching exercises that will gradually restore the muscle length.  A corrective collar or orthotic cranial helmet may also be necessary, depending on the specific needs of the individual patient.  However, if patients fail to respond to these measures, or if there is a worsening of the patient’s facial deformities or severe neck angulation, surgical intervention may be necessary to fully alleviate the symptoms.

My unique endoscopic approach uses instruments similar to those used in arthroscopic knee surgery to carefully remove the scar tissue, release the muscle, and allow the regular course of natural development to occur.  The tiny endoscopic camera enters through a small incision high on the scalp behind the ear and is carefully threaded down the neck until it reaches the treatment area.  There the magnified, high-definition image allows me to observe the muscle, scar, and nerves in full detail, so that the incisions can be made in precisely the right place to avoid damaging the delicate nerves.  Since the nerves remain intact, there is a significantly lower chance of muscle atrophy, and the entire procedure leaves only a single tiny scar that is easily hidden behind the ear.  Once the scar tissue has been removed, the head returns to a natural, balanced position and the muscle is able to resume growing correctly.

I have personally performed this surgical correction on more than 300 patients, and each has shown marked improvement with no infections, no blood clots, and no nerve injuries.  This endoscopic approach has proven itself to be a safe and effective alternative to traditional surgery and has achieved consistently exceptional cosmetic and functional results.  If you would like to schedule a personalized appointment where we can evaluate your child’s specific needs, please contact me, Dr. Fernando Burstein, today.  Be sure to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.


  1. Burstein, FD., Cohen, S.: Endoscopic Surgical Treatment for Congenital Muscular Torticollis. Plastic & Reconstructive Surgery. 101:1:20-4, 1998.
  2. Burstein, FD., Cohen, S., Huang, M., Simms, CA.: Applications of Endoscopic Surgery in Pediatric Patients. Plastic & Reconstructive Surgery. 102:5:1446-51, 1998.
  3. Burstein, FD.: Long Term Experience with Endoscopic Surgical Treatment for Congenital Muscular Torticollis in Infants and Children: A Review of 85 Cases. Plastic & Reconstructive Surgery., 2004 Aug; Vol. 114, No. 2, 491-493.