Congenital myotonic squint, is the most common cause of pediatric squint. It is due to contracture and degeneration of the sternocleidomastoid muscle, which pulls and causes the neck to be crooked. If left untreated, the deformity can worsen with age. The deep fascia of the neck will contract and thicken, the trapezius muscle will become shorter, the carotid artery and blood vessels will contract, the neck and face will develop asymmetrically, the cervical vertebrae and even the upper thoracic vertebrae will develop scoliosis deformation, and the eyes will develop strabismus. What causes congenital myotrabismus? It is commonly believed that congenital myotrabismus is related to abnormal fetal position, birth injury and obstructed labor. The incidence of myotrabismus is significantly higher, with reports of up to 50%, when the fetus is in an abnormal position in the uterus, especially in the breech position. Difficult delivery or birth injury during delivery may cause restriction of blood flow to the sternocleidomastoid muscle, ischemia, hemorrhage, and hematoma mechanization, causing contracture of the sternocleidomastoid muscle and degeneration of the muscle fibers, which leads to the occurrence of myotrabismus. How to treat congenital myotonic levator neck? The disease should be diagnosed as early as possible, and once diagnosed, it should be treated as early as possible. For patients under 1 year old, especially infants under 6 months old, massage and physical therapy are recommended. Massage and manipulation of sternocleidomastoid muscle is feasible during the daytime. A sandbag is used to keep the head in the corrected position after sleep at night. Which children need surgery? When is the best time to do the surgery? Children with congenital myotonic squint do not improve after 1 year of conservative treatment, or they are less than 1 year old, but the sternocleidomastoid contracture is already very obvious and the child’s neck rotation is significantly limited. Such children need surgical treatment. The aim of surgery is to release the sternocleidomastoid muscle and its surrounding tissues, including unipolar release, bipolar release, excision of diseased tissue and extensive release. The best time to operate on a child is between the ages of 1 and 4. Conservative treatment is usually feasible for children within 1 year of age, and the child’s underdeveloped respiratory system makes anesthesia risky, and the difficulty of separating muscles, nerves, and blood vessels during surgery makes surgery risky. Treatment too late can lead to permanent complications such as strabismus and asymmetrical facial development. What measures should be taken after surgery to prevent recurrence of the deformity? Effective post-operative neck fixation and proper manipulation exercises are important measures to prevent recurrence! In young children, it is possible to fix the neck in an overcorrected position for 4-6 weeks with a maxillo-occipital band or a cephalothoracic cast. For older children with more severe disease, traction with a maxillo-occipital band for 1 to 2 weeks and daily manipulation, followed by cephalothoracic cast immobilization for 4 to 6 weeks. After removal of the cast, daily manipulation should be continued for not less than 1 year. This will prevent the recurrence of the deformity.