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Torticollis is a medical condition that is diagnose clinically. It is a deformity of the head and neck where the head tilt and rotary position. This is a common presentation but there are some rare differentials that should be considered. The condition may be congenital or acquired. However, there is no known genetic pattern that may cause this particular condition.

 

The incidence is uncommon. Predominant age for congenital torticollis is newborn while for acquired torticollis it affects child under 10 years old and adults between 30-60 years old. Male and female are equally affected.

 

Signs and symptoms include rotation and tilting of the head to the affected side while chin will rotates to the opposite side. The patients will experience intermittent painful spasms over the neck particularly the trapezius and sternocleidomastoid muscles. In congenital torticollis, it may present with firm, nontender and palpable enlargement of the sternocleidomastoid muscle that is visible at birth. An early sign for acquired torticollis is the stiffness of the neck muscles.

 

Causes are:

 

Congenital

Acquired

Injury at birth to one side of the sternocleidomastoid (traumatic at birth) for example in breech assisted delivery In utero – possible malposition Prenatal injury Some syndromes like: Klippel-Feil Syndrome, Morquio Syndrome, Down Syndrome, Sandifer Syndrome.

Muscular damage from inflammatory disease ( myositis and lymphadenitis) Cervical spine injury Ocular disorder Organic CNS disorder Psychogenic Cervical spondylosis Vestibular dysfunction Retropharyngeal abscess Juvenile idiopathic arthritis Spontaneous atlanto-axial rotary subluxation following acute pharyngitis Acute calcification of cervical disc Trauma Bone dysplasias Neurological tumours (especially tumours of posterior fossa)

 

 

The diagnosis is mainly done by x-ray of the cervical spine. CT scan and MRI usually not required. However it is useful in differential diagnosis especially for acquired cases. Treatment is depends on the underlying cause. For congenital causes, physical therapy will be useful. For acuired cases, soft collar and rest are all needed if the condition occur less than 1 week. If more than that, the patient may require traction. Consider early psychiatric referral if we suspect emotional disorder. Vast majority of patients will respond to non surgical treatment within one year. The rest might need surgical interventions. Surgical release or lenghthening of the sternocleidomastoid might be indicated in some difficult case. Drugs are usually not needed. If the torticollis is a result of drug induced, treatment can include diphenyhydramine or diazepam. Alternative drug like botulinum toxin (ortholinum) injections are being studied for spastic form of torticollis.

 

Periodic follow up is necessary to assess the progress of the patient. Some possible complications include movement disorders, postural disorders, dental malocclusion and facial asymmetry ( in congenital cases).

 

Reference:

1. The Great Ormond Street Colour Handbook of Paediatrics and child Health. Manson Publishing. 2007.

2. Griffith’s 5 minute clinical consult. Lippincott Williams and Wilkins. 2005.

Tags: bone dysplasia, botulinum toxin, head rotate, head tilt, ocular disorder, prenatal injury, sternocleidomastoiud, torticollis

Technorati Tags: bone dysplasia, botulinum toxin, head rotate, head tilt, ocular disorder, prenatal injury, sternocleidomastoiud, torticollis

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