Torticollis Congenital Muscular Torticollis | |
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Incidence | |
The different types of congenital muscular torticollis are frequently observed. | |
Clinical significance | Illustrations |
The later the disease is diagnosed and the treatment started, the worse are the primary findings and the secondary sequels (plagiocephaly, asymmetry of the face, scoliosis of the neck, and ophthalmological sequels), and the more difficult a successful treatment. | show details |
Etiology | |
The congenital muscular torticollis is probably due to an intrauterine compartment syndrome of the sternocleidomastoid muscle. | |
Pathology, anatomical types | |
In neonates and infants the muscular changes lead to a more or less distinct torticollis and/or to a tumor in the sternocleidomastoid muscle following a generalized or localized tumor-like fibrosis. In toddlers and schoolchildren there is only a generalized or localized fibrosis, and the tumor-like fibrosis (which is not a hematoma) is not visible any more, but the torticollis is now pronounced in every case. | |
Pathophysiology | |
The congenital muscular torticollis leads to a decreased torsion and increased inclination of the head on the same side and secondarily to an abnormal posture. | |
Clinical presentation (history, findings) | Illustrations |
The parents tell about a firm mass in the neck and/or about a preferred position of the head and a preferred look to one side; or they are worried about an abnormal shape of the skull (see craniosynostosis). | show details |
Clinical presentation (clinical Skills) | Illustrations |
An optimal clinical examination should be performed in supine position of the infant/toddler which allows a simultaneous palpation of both sternocleidomastoid muscles, and a determination of the rotation of the head to both sides as an objective and reproducible measure of a possible limitation in the movement of the head (normal values 80 to 90 degree to both sides. Cheng JCY et al. J Pediatr Surg 35:1091,2000). | show details |
Natural history | Illustration |
The congenital muscular torticollis may be reversible clinically in infants in 80 %. 20 % need surgery either as infants or as toddlers, or later in life in missed cases (see clinical picture). | show details |
Differential diagnosis | Illustrations |
Amongst the congenital causes of torticollis, the following should be considered: congenital postural torticollis, Klippel-Feil syndrome and Sprengel's deformity, and C1 to C2 articular malformations. | show details |
Work-up examinations | Illustration |
Additional examinations depend on the age of the patient and the suspected differential diagnoses according to the history and the local findings. | show details |
Therapy | Illustrations |
The sternocleidomastoid tumor and fibrosis are resistant to all therapies; however, the former disappears spontaneously. Surgery is indicated: No long-term case-controlled studies are available about alternative methods of treatment. | show details |
Prognosis | Illustrations |
Prognosis depends on the time of diagnosis, the degree of sequels, and the appropriateness of the measures.
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