Affiliations: [a] Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA | [b] Prosthetic Laboratories of Rochester, Inc., Rochester, MN, USA | [c] Department of Physical Medicine and Rehabilitation, Rochester, MN, USA | [d] Department of Pediatric and Adolescent Medicine, Rochester, MN, USA | [e] Department of Neurology, Rochester, MN, USA
Correspondence:
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Corresponding author: Joline E. Brandenburg, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Tel.: +1 507 266 8913; Fax: +1 507 284 3431; E-mail:brandenburg.joline@mayo.edu
Abstract: PURPOSE: This case report examines the use of a custom neck
orthosis following onabotulinumtoxinA (BoNT-A) injections for the treatment
of congenital muscular torticollis (CMT) that has not been responsive to
conservative treatment or previous injections. METHODS: The patient was fitted for a custom neck orthosis
following BoNT-A injections for refractory CMT. Clinical outcomes were
evaluated with head tilt, cervical rotation, and neck passive range of
motion (PROM) measurements. Parental reports of patient tolerance of the
orthosis and family satisfaction of results were obtained through survey. RESULTS: With use of the orthosis following BoNT-A injections, the
patient's head tilt improved from 45° to an intermittent tilt of 10°
and neck PROM to the left improved from 70° to 90°. He wore the neck
orthosis for 8 to 10 hours per day for 3 months, experienced no major
complications, and tolerated it well. On follow-up survey, the family
reported satisfaction with the results. CONCLUSION: This case provides evidence that a custom neck orthosis
after BoNT-A injection may be an effective treatment of refractory CMT
before or replacing surgical intervention.
