Torticollis- familial


Torticollis, familial (medical condition): A familial neck disorder where the neck movement is limited and the head is tilted to one side.


* Tilted head * Limited neck movement * Elevated chin * Chin turned to opposite side of head tilt * Physiotherapy or surgery


o Congenital muscular torticollis –Most likely secondary to birth trauma –SCM muscle is stretched during delivery, a hematoma results, and the SCM muscle spasms in response –SCM muscle may become fibrotic * Brachial nerve plexus injury –Also associated with birth trauma * Benign paroxymal torticollis –Occurs in infants and young children –Abrupt onset with pallor and vomiting –May be a migraine variant * Muscular spasm –May occur after prolonged exposure to a cold stimulus such as wind o Dystonic reaction –May be drug reaction to antipsychotics, metoclopramide, prochlorperazine, trimethobenzamide –May be part of a dysmotility syndrome such as myasthenia gravis or Huntington chorea + HEENT infection –May occur with cervical adenitis, otitis, or mastoiditis –Local pressure on the neighboring SCM muscle causes irritation and spasm of the muscle + Atlantoaxial subluxation –Associated with Down syndrome, achondroplasia –May be secondary to fracture, infection, or malignancy of the cervical spine o Post-upper respiratory infection –May occur in young children –Retropharyngeal edema displaces the atlantoaxial junction + Ocular torticollis –A compensatory mechanism enacted by patients with trochlear nerve palsy or superior oblique muscle weakness –Head positioning results in better alignment of the affected eye with the unaffected eye, and minimizes diplopia *GERD, hiatal hernia –May manifest as neck torsion (known as Sandifer syndrome) + Klippel-Feil syndrome


* 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