What is torticollis?
A condition in which the neck is tilted to one side is called torticollis. When people refer to torticollis, they usually mean congenital muscular torticollis, which results from shortening of the sternocleidomastoid muscle on one side of the neck, causing the head to tilt toward the shortened muscle and the face to turn to the opposite side. Although the exact cause of muscular torticollis is not known, it essentially involves a haematoma within the sheath of the sternocleidomastoid muscle, which causes shortening of the muscle fibres. The child usually has head asymmetry, with flattening on the side of the shortening, known as plagiocephaly. Congenital muscular torticollis is not a rare finding, occurring in approximately 1% of children after birth. It has also been observed that children with torticollis are more likely to have developmental hip dysplasia and clubfoot (equinovarus).
How is torticollis diagnosed?
Torticollis is usually diagnosed during a baby's first hip ultrasound examination by a paediatric orthopaedic specialist. During the examination, it is necessary to check whether the baby can turn their head equally to both sides. If the baby does not turn their head symmetrically, a lump or thickening should be looked for on the side of the neck where movement is restricted. In congenital muscular torticollis, the lump can be felt laterally and lower on the neck and is not painful. Restricted head movement can also occur in children who sustained a collarbone fracture during birth, but in that case the thickening can be felt over the collarbone. In congenital muscular torticollis, facial asymmetry is not pronounced in the first months of life. However, if left untreated, facial asymmetry will progress over time. To be as confident as possible in the diagnosis, a neck ultrasound is usually recommended, since neck fibromatosis can produce a similar picture to torticollis. In older children, torticollis can be caused by pharyngeal inflammation that irritates the neck muscles and tilts the head to one side (Grisel's syndrome), as well as by tumours and visual or hearing disorders.
How is torticollis treated?
The main treatment for torticollis is physical therapy involving stretching of the shortened sternocleidomastoid muscle, aiming to achieve as full a range of neck motion as possible. Physical therapy should begin as early as possible to prevent facial asymmetry from developing. Children usually protest during physical therapy sessions, but it is important to persevere until full range of motion is achieved. Sometimes torticollis is detected later, or physical therapy is not sufficiently successful. In that case, surgery is required, but only once the child has reached kindergarten age.
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