What is torticollis?

Torticollis refers to a condition in which the head is tilted to one side. When talking about torticollis, it usually refers to congenital muscular torticollis, which results from the shortening of the sternocleidomastoid muscle on one side of the neck, causing the head to tilt to the side of the shortened muscle and the face to turn in the opposite direction. Essentially, it is a hematoma within the sheath of the sternocleidomastoid muscle, causing a shortening of muscle fibers. The child typically has asymmetry of the head, a tilt to the side of the shortening, which is referred to as plagiocephaly. Congenital muscular torticollis is not uncommon, being described in approximately 1% of newborns. It has also been observed that children with torticollis may more frequently have congenital hip dysplasia and clubfoot.

How to confirm torticollis?

Torticollis is usually diagnosed during the first ultrasound examination of infant hips by a pediatric orthopedic surgeon. During the examination of the infant, it is necessary to check whether the child can turn its head equally in both directions. In cases where the child cannot turn its head symmetrically, a lump or thickening should be sought 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. Limited mobility of the head may also occur in children who have suffered a clavicle fracture at birth, but in this case, the thickening can be felt above the clavicle. 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 more certain of the diagnosis, an ultrasound of the neck is usually recommended, as fibromatosis of the neck can mimic the appearance of torticollis. In older children, torticollis can be caused by pharyngitis, which then stimulates neck muscles and tilts the head to one side (Grisel’s syndrome), as well as tumors, visual and hearing impairments.

How to treat torticollis?

The main method of treating torticollis is physical therapy involving the stretching of the shortened sternocleidomastoid muscle to achieve the maximum range of neck motion. Physical therapy should start as early as possible to prevent facial asymmetry from developing. Children often resist during physical therapy sessions; however, perseverance is crucial until the full range of motion is achieved. Sometimes torticollis is discovered later, or physical therapy may not be successful enough. In such cases, surgery may be necessary, but only in the preschool age of the child.

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