A 3-week-old infant presents with the head persistently tilted to the right and the chin turned to the left. There is a firm, non-tender fusiform mass within the lower third of the right sternocleidomastoid muscle. The child was a breech delivery. What is the most appropriate initial management?

• A Physiotherapy with passive stretching exercises ✓
• B Excision biopsy of the mass
• C Intralesional steroid injection
• D Botulinum toxin injection into the mass

Explanation

This is sternocleidomastoid tumour of infancy (fibromatosis colli), a benign fibroblastic lesion associated with breech or forceps delivery, producing congenital muscular torticollis. Initial treatment is conservative: passive stretching physiotherapy started early resolves most cases. Excision is reserved for refractory deformity after the first year, since surgery risks damage to the spinal accessory nerve in this location. Steroids and botulinum toxin are not first-line measures.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.