A 3-week-old infant has a firm, non-tender fusiform swelling within the body of the right sternocleidomastoid muscle. The head is tilted to the right with the chin turned to the left. Ultrasound confirms a mass confined to the muscle. The most appropriate initial management is:

• A Excision biopsy of the mass
• B Stretching physiotherapy exercises ✓
• C Intralesional steroid injection
• D Observation alone without any intervention

Explanation

This is sternomastoid tumour of infancy (fibromatosis colli), a benign fibroblastic lesion presenting with congenital muscular torticollis. First-line treatment is passive stretching physiotherapy, which resolves most lesions within a year. Surgical tenotomy or release is reserved for refractory cases with persistent deformity after conservative therapy. Excision biopsy is unnecessary because ultrasound is diagnostic, steroids have no role, and observation alone risks permanent facial asymmetry and plagiocephaly.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.