Congenital Muscular Torticollis

Description

Torticollis is a condition characterized by abnormal rotation and lateral flexion of the neck. It may be congenital or acquired. Congenital torticollis is the most common form and may be muscular, osseous (resulting from congenital vertebral anomalies), or associated with visual disorders or Klippel-Feil syndrome. Acquired torticollis may be painful, resulting from trauma or inflammation, or painless and associated with central nervous system tumors, hemiparesis, or functional neurological disorders.

The most common form is congenital muscular torticollis, which is characterized by shortening and fibrosis of the sternocleidomastoid muscle. It is believed to result from intrauterine compression of the muscle, leading to impaired blood supply, muscle ischemia, fibrosis, and occasionally nerve injury.

Symptoms

The right sternocleidomastoid muscle is affected more frequently than the left. The head is tilted toward the affected side, while the chin is rotated toward the unaffected side. Congenital muscular torticollis may be associated with developmental dysplasia of the hip, foot deformities, and facial asymmetry.

Diagnosis

The diagnosis is primarily based on clinical examination. In newborns, persistent head tilt toward the affected side is usually evident. In approximately 20% of cases, rupture of the sternocleidomastoid muscle during birth results in a palpable mass near its clavicular attachment.

Treatment

Conservative treatment is successful in approximately 90% of cases. From birth until 3–4 months of age, treatment consists of stretching exercises and the use of corrective collars when indicated. Parents are encouraged to feed, position, and interact with the infant from the affected side to stimulate active head rotation. Stretching exercises are most effective during the first year of life. If torticollis persists despite conservative treatment, surgical release of the sternocleidomastoid muscle may be performed between 1 and 4 years of age.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology