Torticollis

Torticollis, or wry neck, results from scarring and a mass in the middle portion of the large muscle in the neck known as the sternocleidomastoid muscle (Figure 1).

The cause is unclear and appears to be higher in patients who are in breech presentation at birth. The mass is tumor-like and has been called a pseudotumor, although there is nothing to suggest it is anything but scarring of the muscle. In most infants the mass is noted between two and eight weeks of age. A firm lump is felt and the position of the face may be turned away from the mass and tilted upward. Extensive x-ray studies are generally not needed, although ultrasonography will demonstrate the mass and the diagnosis without subjecting the child to unneeded radiation. Torticollis or a solid neck mass in an older child demands careful evaluation and more tests for a tumor or other neck spine abnormalities.

Treatment
In most infants, operative treatment is NOT necessary. Passive stretching of the neck is recommended. Proper positioning of the patient to encourage them looking towards the side of the mass during feeding or when positioned in a room may add to successful therapy. Massage may be of some benefit, but early range of motion stretching is often helpful. Criteria for operation is poor growth of one side of the face/head, which may result in permanent disfigurement. The overwhelming majority of patients, however, do not require surgery.

When operative treatment is indicated, it involves cutting across the connective tissue at the base of the neck, as well as the sternocleidomastoid muscle, so as to release the tension and allow the head to return to a normal position. Postoperatively, intensive physical therapy to promote full rotation of the neck in both directions is started as soon as is feasible.

Article and graphics adapted from O'Neill: Principles of Pediatric Surgery. © 2003, Elsevier.ack to Resources for Parents