Surgical Management of Congenital Muscular Torticollis in a Child Using Z-plasty: A Case Report and Literature Review.

Congenital muscular torticollis (CMT) is characterized by unilateral shortening of the sternocleidomastoid muscle (SCM), producing ipsilateral head tilt and contralateral rotation of the face and chin. It usually manifests during infancy and responds favorably to conservative treatment based on physiotherapy; spontaneous resolution is expected in the majority of cases. However, when diagnosis is delayed and patients present at a later age, conservative approaches tend to yield limited outcomes, neglected presentations remain prevalent in developing countries such as Morocco, where patients often present beyond the optimal age for conservative management. We report the case of an 11-year-old female patient with CMT, who was successfully managed through unipolar SCM release combined with Z-plasty lengthening, yielding significant functional improvement and a satisfactory cosmetic outcome. This case underscores that surgical correction remains a viable and effective therapeutic option in older children with neglected CMT, even when conservative management has failed and the deformity has become chronic.