In severe congenital myotonic cervix, if the mass has not completely disappeared after about one year of conservative treatment, or if the muscle has been severely fibrotic contracture hardening, obviously pulling the affected side of the head tilt, limiting the normal angle of the child to the affected side of the head to turn the child’s head, so that the child can’t restore the normal rotation of 85-90 degrees of function by either their own movement or external forces, surgery can be considered, note that the prerequisite for surgery is the muscle lesions, the loss of normal elasticity, the functional hardening contracture like bone, not ultrasound shows that there is normal muscle fiber Note that surgery should be performed if the muscle is diseased and has lost its normal elasticity, or if the muscle is functionally sclerotic and contractured like a bone, not if it has normal muscle fibers as shown on ultrasound. This means that normal muscles cannot be easily removed from a child with habitual (postural) strabismus, even if the child has not fully recovered from balance problems after the age of one year. For children whose lumps have not completely disappeared, the decision to operate should be made after six months or a year of stopping treatment and observing the condition of the lumps, during which time the child should be turned at home by himself to correct the habit, and should be rechecked once every three months. According to personal clinical observation, unless the treatment is started too aggressively or inappropriately, most of the lumps will disappear around six months to one and a half years of age, and individual children will not completely disappear until two and a half to three years of age. After the disappearance of the mass, it depends on whether the remaining contracture of the sternocleidomastoid muscle is hardening and affecting the rotation of the head to the affected side to decide whether to operate or not and the optimal time to operate, and try to retain as many normal functioning muscles as possible for a symmetrical appearance. Generally, most scholars in China believe that the optimal time for surgery is between 1.5 and 3 years of age, but individual children who do not have obvious symptoms and whose functions are basically not limited may choose to have surgery after 3 years of age. After the operation, we should pay attention to continue to insist on home stretching and head turning for not less than 3 months until we are sure that the sternocleidomastoid muscle will not be re-adhesive and become shorter, and at the same time, we should keep reminding and correcting the child’s habits, and in serious cases, we can bring orthopedic appliances to help stabilize the muscles and stretching, and insist on bringing the child to the surgeon as well as the rehabilitation doctor for regular checkups. Parents should not have the wrong idea that things will get better after surgery.