Torticollis
Olga Zhadan
“Torticollis” is the term for twisted or rotated neck, derived from Latin, “tortus”—“twisted” and “collum”—“neck.”
PATHOPHYSIOLOGY
Torticollis can be congenital or acquired.
Congenital—postural deformity of the neck, most common type, results from fibrosis (deposition of collagen and fibroblasts around individual muscle fibers that undergo atrophy) and shortening in sternocleidomastoid muscle, which pulls the head and neck to the side of lesion.
Three types of congenital torticollis, in order of increasing severity:
Postural—babies have postural preference but no muscle tightness or restriction to passive range of motion.
Muscular—tightness of the sternocleidomastoid muscle and limitation of passive range of motion.
Sternocleidomastoid muscle mass (also called fibromatosis colli)—thickening (palpable fibrous tissue) of the sternocleidomastoid muscle and limitation of passive range of motion are developed.
Association with breech presentations and other abnormal obstetric positions supports both the tumor etiology and the injury (due to difficult extraction), although torticollis is also found in the babies delivered by cesarean section. No single explanation of torticollis etiology exists.
Acquired torticollis develops at any age secondary to cervical hemivertebra and imbalance of the ocular muscles, otolaryngologic infection, and gastroesophageal reflux (Sandifer syndrome).
Other causes of torticollis: Klippel-Feil anomaly (congenital fusion of any 2 of the 7 cervical vertebrae), different neurologic disorders.1
CLINICAL PRESENTATION AND DIAGNOSIS
In 66% of cases, torticollis presents as “tumor” in the muscle, and in 34%, as fibrosis.
Usually the mass is not found in the neonatal period and first noted at the “well-baby” checkup 6 weeks after birth.
The babies have characteristic posture: face and chin rotated away from the affected side and the head tilted toward the ipsilateral shoulder.2,3
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