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Wednesday, February 3, 2021

Torticollis – congenital wry neck

Torticollis – congenital wry neck is a muscular disease with curved neck and limited head mobility in neonatal phase of development. Patients show muscle swelling or m.sternocleidomastoideus contracture, with no osteo, neural, or ocular disorders. The disease can manifest in older children as well.

TORTICOLLIS ETIOLOGY

Torticollis etiology can be different – some authors say birth trauma can be the cause while others speak of genetics. In some children, there are no signs pointing to any etiology.

TORTICOLLIS CLINICAL IMAGE

Torticollis clinical image is characterized by curved head posture (in the first weeks after pregnancy). Head mobility is limited to the one side of the head. Plagiocephaly occurs later on (asymmetric back part of the head). When the head rotates to the affected side, you can palpate shortened and tense m.sternocleidomastoideus. In children who are older than 3 months, facial asymmetry is also present; meaning that one half of the face is smaller and underdeveloped. 

Children with torticollis who do not receive treatment have a permanent facial asymmetry. Older untreated children can develop cervical and thoracic scoliosis. 

TORTICOLLIS DIFFERENTIAL DIAGNOSIS 

RTG anteroposterior and side projections will warn us about possible congenital bone anomalies of the cervical spine (Klipell-Feil syndrome, atlantooccipital fusion, odontoid anomalies). Traumatic changes are not always visible on RTG. Inflammatory diseases which can cause torticollis are: neck lymphadenitis, angina, infectious parotitis. Patients with ocular dysfunction try to balance their eyesight through curvature of the neck and can thus develop secondary muscle torticollis

It is important to point out that in children under 3 months of age apposition torticollis is quite common – with no sternocleidomastoideus damage nor signs of disease. It is treated with exercises, rubber neckband, corrective pillows, and nutritional changes – the treatment is almost always successful. 

TREATMENT OF TORTICOLLIS

Physical therapy and medicinal gymnastics play the most important role in treating torticollis. Exercises focus on stretching the m.sternocleidomastoideus in order to physically prevent the imbalance between left and right side strength. In most cases, the treatment is a great success. In some difficult cases (usually when we start very late with physical therapy – after 1-2 years of age) surgery must be used to extend/relax m.sternocleidomastoideus.

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