What Is Torticollis?

Torticollis can be divided into congenital muscular torticollis and congenital torticollis. The former is a congenital neck deformity caused by a sternocleidomastoid muscle contracture, which is quite common; the latter is a torticollis caused by cervical vertebrae malformation, which is rare.

Basic Information

English name: torticollis
English alias: wryneck
Visiting department: orthopedics

Common causes: Abnormal intrauterine pressure, immature fetal position, difficult delivery and use of forceps, etc.
Common symptoms: Torticollis deformity, neck mass, facial deformity
Contagious: no

Causes of torticollis

The cause of congenital muscular torticollis is unknown. However, most scholars believe that the abnormal pressure in the uterus or the fetal position of the embryo is not the main cause of congenital muscular torticollis. If the fetus is improperly placed in the uterus or receives abnormal uterine wall pressure, one side of the neck can be compressed, and local blood circulation in the sternocleidomastoid muscle is hindered, which causes the muscle to undergo ischemic fibrosis and cause torticollis. Some scholars also It is thought that the sternocleidomastoid muscle nutrient vascular embolism leads to muscle fibrosis and torticollis.

Difficult labor and the use of forceps are one of the causes of muscular torticollis. Because this disease mostly occurs in gluteal producers, but the examination of the local mass of the sternocleidomastoid muscle did not reveal signs of old bleeding, so this view has not been confirmed.

One-fifth of children with this disease have a clear family history, so it is believed that its occurrence is genetically related, and such children often have congenital acetabular dysplasia and other deformities in other parts.

Clinical manifestations of torticollis

Torticollis deformity

After the baby is born, the mother can find that the child's head is inclined toward the affected side, the face is rotated toward the healthy side, and the lower jaw is pointed at the healthy side shoulder. The torticollis deformity is more obvious after 2 to 3 weeks. Turning your head to the healthy side is obviously limited, and those with mild symptoms should be observed carefully to find out. This symptom gets worse with the growth and development of the child.

2. Neck mass

Neck masses can usually be touched after birth or within 2 weeks after birth. They are located in the middle and lower segments of the sternocleidomastoid muscle, which are more common on the right side. This mass is spindle-shaped and has no tenderness. It usually reaches its maximum after 1 to 2 months, and then gradually shrinks to completely disappear. In some of these children, the mass does not disappear and muscle fibrosis and contracture cause torticollis. .

3. Facial deformities

Congenital muscular torticollis is not effectively treated early, and facial deformities will appear after 2 years of age. The main manifestations are facial asymmetry, asymmetric distance from the outer corner of the eye to the corner of the mouth, shortened distance on the affected side, and increased on the healthy side. The plane of the affected eye's position is lowered. Because the eyes are not on the same horizontal line, visual fatigue is easy to occur and vision loss occurs. The healthy side is round and full, while the affected side is narrow and flat. Compensatory scoliosis can occur in the cervical spine. In addition, the child's entire face, including the nose and ears, can also change asymmetrically.

In addition to the above main manifestations, this disease can still be combined with congenital acetabular dislocation and other cervical deformities.

Torticollis

Ultrasound examination

Especially for children with congenital muscular torticollis, ultrasound can accurately identify other diseases of the neck, such as cervical cystic lymphangioma and cervical lymphadenopathy. Especially for those who have disappeared at the time of consultation, ultrasound examination is more important.

2.X-ray inspection

It is beneficial to identify torticollis caused by different causes, such as osteotoothral neck caused by occipital neck deformity and torticollis caused by spontaneous atlantoid subluxation of the atlas generally do not produce contracture and mass of the sternocleidomastoid muscle. Most had a history of minor trauma or upper respiratory infections.

Diagnosis of torticollis

Make a diagnosis based on clinical manifestations and related tests. Cases that are difficult to be diagnosed by the above examination methods can be examined by CT, which can provide clearer images, which is helpful for diagnosis and excludes organic lesions.

Differential diagnosis of torticollis

It should be noted that the identification of torticollis caused by the following reasons is clearer:

Congenital torticollis

The disease is mostly caused by congenital occipital neck deformities, including short neck deformities, skull base depressions, hemivertebral deformities, atlanto-occipital fusion, and dentate process malformations. The above diseases can cause torticollis and facial asymmetry, but generally do not produce the typical cord-like contracture bands and masses of the sternocleidomastoid muscle. X-ray examination can confirm the above diagnosis.

2. Pediatric cervical lymphadenitis

With cervical lymphadenitis in infancy, torticollis can occur rapidly and a lump in the neck can occur, but this lump is often not significantly located within the papillary muscles of the chest.

3. Spontaneous atlantoaxial rotational subluxation

Atlantoaxial rotational subluxation can also cause torticollis, but this disease has a history of minor trauma or upper respiratory tract infections. The main symptoms are limited neck rotation and neck pain, and no tension in the sternocleidomastoid muscle. Strips, X-rays can be identified.

4. Cervical tuberculosis

Cervical tuberculosis can cause sternocleidomastoid muscle spasm and produce torticollis, but such patients have obvious neck pain, neck movements are significantly restricted, and the jaw is biased to the affected side. X-ray examination can confirm the diagnosis.

In addition, it needs to be distinguished from torticollis caused by snoring torticollis, habitual torticollis, traumatic torticollis, and torticollis caused by sequelae of polio.

Torticollis complications

If the congenital muscular torticollis is not effectively treated at an early stage, facial deformities may occur after 2 years of age. The main manifestations are facial asymmetry, asymmetric distance from the outer corner of the eye to the corner of the mouth, shortened distance on the affected side, and increased on the healthy side. The plane of the affected eye's position is lowered. Because the eyes are not on the same horizontal line, visual fatigue is easy to occur and vision loss occurs. The healthy side is round and full, while the affected side is narrow and flat. Compensatory scoliosis can occur in the cervical spine. In addition, the child's entire face, including the nose and ears, can also change asymmetrically.

Torticollis treatment

Non-surgical treatment

For children under half a year of age, non-surgical treatment can achieve satisfactory results. Therefore, once diagnosed, treatment should be made as soon as possible. Non-surgical treatments include topical hot compresses, massage, bed fixation, and manual traction.

2. Surgical treatment

(1) Indications and contraindications for surgery Applicable to those who are ineffective for conservative treatment over the age of half a year; Those with significant torticollis deformity under 12 years of age; Surgical treatment can be considered if the facial deformity is not serious over 12 years of age; For adults, due to deformity It has existed for many years. Not only will facial deformities become more apparent after surgery, but vision will also change due to inadequate new posture after surgery.

(2) Surgery method Sternocleidomastoid amputation is one of the more commonly used surgical methods. Make a transverse incision on the clavicle, revealing the sternocleidomastoid sternal head and clavicle head, cut off above the attachment point, and loosen the surrounding fascial tissue. Care should be taken to avoid injury to the cervical arteries, veins and nerves during the operation. Partial removal of the sternocleidomastoid muscle is suitable for those with obvious neck masses. It can be used to remove the mass of the sternocleidomastoid muscle. Total sternocleidomastoid muscle resection is suitable for adolescent patients. If the entire sternocleidomastoid muscle is scarred, it can be removed in its entirety. Sternocleidomastoid muscle extension The sternocleidomastoid muscle clavicle head is cut off and the sternal head is extended in a "Z" shape. The advantages of this operation are: correction of head and neck distortion and restoration of normal neck function; without destroying the normal neck triangle body surface shape, avoiding other surgical methods to leave the neck deformity or abnormal flat deformity, making the neck beautiful and symmetrical. The upper and lower ends of the sternocleidomastoid muscle are combined with angioplasty and angioplasty. Some scholars believe that this operation can be used for older children or those who have failed other operations. Methods: The sternocleidomastoid muscle mastoid side and the clavicle head side were completely cut off, and the sternal head side was extended in a "Z" shape.

(3) Postoperative management Patients with severe torticollis and uncooperative children should be corrected with head-neck-thoracic plaster to maintain their position.