CONGENITAL TORTICOLLIS

Congenital Torticollis : Congenital muscular torticollis is a disorder characterize by shortening of the cervical muscles, most commonly the sternocleidomastoid (SCM) muscle, and tilting of the head to the opposite side. This is the result of endomysial fibrosis of the SCM muscle. There is a relationship between birth position and the side affected by the contracture.

Congenital torticollis causes: plagiocephaly (a craniofacial deformity), fascial asymmetry (hemihypoplasia), scoliosis and atrophy of the ipsilateral trapezius muscle if not corrected. Torticollis can develop at any age, although is more common during the first six months of life. The SCM muscle can be a fibrous mass, or a palpable tumor 1-3 cm in diameter within the substance of the muscle is identified by two to three weeks of age.

Management is conservative in most cases using early physiotherapy exercises a mean duration of three months to achieve full passive neck range of motion. The severity of restriction of motion is the strongest predictor of treatment duration. Those children with failed medical therapy or the development of fascial hemihypoplasia should undergo surgical transection of the SCM muscle.