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Torticollis
Also known as wry neck or loxia.
Defined as an abnormal, asymmetrical head or neck position, which may be due to a variety of causes.
It is a fixed or dynamic tilt, rotation or flexion of the head and/or neck.
Described by the positions of head and neck: laterocollis : the head is tipped towards the shoulder, rotational torticollis : the head rotates along the longitudal axis, anterocollis : forward flexion of the head and neck and retrocollis : hyperextension of head and neck backwards.
In some patients a combination of these movements can often be observed.
A number of clinical conditions may lead to its development including: muscular fibrosis, congenital spine abnormalities, toxic or traumatic brain injury.
Most common type of torticollis in children is due to trauma.
The etiology of congenital muscular torticollis is unknown.
Incidence of congenital torticollis is 0.3-2.0 %.
Birth trauma or intrauterine malposition are considered the causes of damage to the sternocleidomastoid muscle in the neck resulting in a shortening or excessive contraction of the muscle, impairing its range of motion in both rotation and lateral bending.
The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side.
A sternocleidomastoid tumor may be found at the age of two to four weeks and it eventually disappears, usually by the age of eight months,
Treatment with physical therapy such as stretching, and strengthening exercises to improve muscular balance.
About 5–10% of cases fail to respond to stretching and require surgical release of the muscle.
Acquired torticollis can result from scarring or disease of cervical vertebrae, adenitis, tonsillitis, arthritis, enlarged cervical glands, retropharyngeal abscess, or cerebellar tumors.
Acquired torticollis may be spasmodic or permanent.
Pott’s Disease, tuberculosis of the spine, may be associated.
A self-limiting spontaneously form of torticollis, the stiff neck, with one or more painful neck muscles is the most common type of acquired disease and clears spontaneously in 1–4 weeks.
The muscles most commonly involved are the sternocleidomastoid and trapezius.
In most cases no clear cause is found.
Posterior fossa tumors can cause torticollis, and these problems must be treated surgically.
Infections in the posterior pharynx can irritate the nerves of the neck muscles and cause torticollis.
Ear infections and surgical removal of the adenoids can cause a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection.
Antipsychotics, antiemetics and phenothiazines can cause torticollis.
Infants often develop torticollis from lying on their back in car seats, swings, bouncers, strollers and on play mats.
Infants have a higher risk of plagiocephaly or flat head syndrome.
Almost always preventable in infants as correct positioning is important, and most pediatricians recommend repositioning the baby’s head every 2–3 hours during waking hours.
Uncorrected torticollis in a newborn, if not corrected can result in facial asymmetry.
Treatments include: exercise to increase neck stability, heat therapy, and massage.
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma, a physical examination to determine neurological clinical findings, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot.
Radiographs of the cervical spine should be obtained to rule out obvious bony abnormalities.
MRI should be considered to establish structural problems or other processes.
Eye conditions such as IV cranial nerve palsy or nystagmus need to be ruled out as causes of torticollis.