Congenital torticollis
Overview
A rare condition characterized by a twisted neck at birth .
Symptoms
* Inclination of head * Rotation of back of head * Bone growths on clavicle * Downward slanting eyebrow on affected side * Broad face * Vertically shortened face * Deformed cranial vault
Causes
Torticollis may be congenital or acquired. The three types of acquired torticollis — acute, spasmodic, and hysterical — have differing causes. The acute form results from muscular damage caused by inflammatory diseases, such as myositis, lymphadenitis, or tuberculosis (TB); from cervical spinal injuries that produce scar tissue contracture; and, less commonly, from tumor or medication. The spasmodic form results from rhythmic muscle spasms caused by an organic central nervous system disorder (probably due to irritation of the nerve root by arthritis or osteomyelitis). Hysterical torticollis is due to a psychogenic inability to control neck muscles. Acquired torticollis usually develops during the first 10 years of life or between ages 30 and 60. Incidence of congenital (muscular) torticollis is highest in infants after difficult delivery (breech presentation), in firstborn infants, and in girls. Possible causes of congenital torticollis include malposition of the head in utero, prenatal injury, fibroma, interruption of blood supply, or fibrotic rupture of the sternocleidomastoid muscle, with hematoma and scar formation.
Diagnosis
* Useful distinctionis whether neck stiffness or torticollis is congenital or acquired. Congenitalmuscular torticollis can usually be diagnosed by physical exam.Cervical spine radiography can diagnose skeletal spine anomaliesand atlantoaxial instability. * Most common acquired causes of neckstiffness or torticollis are muscle strain, other musculoskeletaltrauma, pharyngitis, tonsillitis, cervical adenitis, viral myositis,and meningitis. * With history of trauma, cervical spineradiography should be performed. * Presence of fever usually signifiesinfection. * Lumbar puncture should be performedwith suspected meningitis. * Fever and localized tenderness of cervicalspine suggests cervical osteomyelitis, and cervical spine radiographyand bone scintigraphy are often helpful. * History and physical exam should suggestpresence of other causes of neck stiffness and torticollis. * CT is initial procedure of choice forsuspected subarachnoid hemorrhage or primary brain tumor. This proceduremay be followed by MRI.
Prognosis
Prognosis of Congenital torticollis: good response to early treatment
Treatment
* Physical therapy including massage and stretching of the contracted muscle * For infants, selective positioning and placement of visual stimuli to promote stretching of the affected muscle * Surgical release of the SCM muscle * Surgical stabilization of the alantoaxial joint * Discontinuation of causative medications * Ophthalmic consultation for EOM impairment