Custom neck orthosis in combination with onabotulinumtoxinA for the treatment of refractory congenital muscular torticollis: A case report

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.