To analyze head tilt and facial asymmetry in congenital muscular torticollis.

The 37 cases (mean age: 8.5 years) of congenital muscular torticollis [23 operative cases (14 bipolar release, 9 unipolar release) and 14 non-operative cases] were reviewed. Measurements included: head tilt, horizontal facial asymmetry angle, midfacial asymmetry angle on photographs; craniovertical angle, orbital plane-cranial horizontal line angle on cephalograms; and the angle between two reference lines connecting the mastoid processes and the spinous processes on C-spine radiographs.

The results in both operative/non-operative groups were measured as follows: mean head tilt of 6.6 °/4.3 °, mean horizontal facial asymmetry angle of 3.4 °/1.9 °, mean midfacial asymmetry angle of 3.2 °/2.4 °on photographs; mean head tilt of 17.1 °/4.7 °on C-spine radiographs; mean craniovertical angle of 2.9 °/2.1 °, mean orbital plane-cranial horizontal line angle of 3.3 °/2.0 °on cephalograms.

The facial asymmetry in congenital muscular torticollis become more severe with increased age at treatment and with a more severe head tilt. Horizontal facial asymmetry around the orbits is more distinctive than midfacial asymmetry in torticollis-related facial asymmetry.