Pediatric Torticollis Surgery Workup

  • Author: Amulya K Saxena, MD, PhD; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: Mar 11, 2010
 

Laboratory Studies

  • No specific laboratory blood tests are required in the workup of patients with torticollis.
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Imaging Studies

  • Although the diagnosis is easily made upon physical examination by an experienced clinician, ultrasonography is the most commonly ordered test.[9, 10]
  • MRI may be useful in patients with nonmuscular causes of torticollis; however, MRI is not recommended in asymptomatic patients with infantile torticollis.[11]
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Diagnostic Procedures

  • Clinical examination
    • The entire length of the muscle must be palpated to determine if fibrosis or an area of fibrosis is present along the entire length of the muscle.
    • The anterior border of the muscle must be palpated. It generally stands out as a tight band. This may be difficult to detect in small infants because the neck is relatively short.
    • Alternative differential diagnoses must be considered if the muscle is neither short nor prominent.
  • Differential diagnosis
    • Abnormal position in utero
    • Cervical hemivertebrae
    • Cervical lymphadenitis
    • Cervical abscess
    • Retropharyngeal abscess
    • Ocular muscle torticollis
    • Tumors of the posterior fossa
    • Atlantooccipital subluxation
    • Sandifer syndrome
    • Postural abnormalities
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Histologic Findings

Histopathologic findings include fibrous replacement of skeletal muscle fibers that undergo atrophy. The degree of fibrosis and its extent or distribution may vary. Even in neonates, the fibrous tissue is mature. This finding indicates that the disease began before birth.

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Contributor Information and Disclosures
Author

Amulya K Saxena, MD, PhD  Associate Professor, Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria

Amulya K Saxena, MD, PhD is a member of the following medical societies: Austrian Society for Pediatric and Adolescent Surgery, European Pediatric Surgeons Association, German Society of Pediatric Surgery, German Society of Surgery, International Pediatric Endosurgery Group, and Tissue Engineering and Regenerative Medicine International Society (TERMIS)

Disclosure: Nothing to disclose.

Specialty Editor Board

Diana Farmer, MD  Professor and Chief of Pediatric Surgery, Vice Chair, Department of Surgery, University of California, San Francisco, School of Medicine; Surgeon-in-Chief, UCSF Children's Hospital

Diana Farmer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Nicholas A Shorter, MD  Professor of Clinical Surgery and Clinical Pediatrics, State University of New York-Downstate University; Division Chief, Department of Surgery, Division of Pediatric Surgery, State University of New York-Downstate Medical Center

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD  Professor of Surgery, Feinberg School of Medicine, Northwestern University; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

References

  1. Bredenkamp JK, Hoover LA, Berke GS, Shaw A. Congenital muscular torticollis. A spectrum of disease. Arch Otolaryngol Head Neck Surg. Feb 1990;116(2):212-6. [Medline].

  2. Davids JR, Wenger DR, Mubarak SJ. Congenital muscular torticollis: sequela of intrauterine or perinatal compartment syndrome. J Pediatr Orthop. Mar-Apr 1993;13(2):141-7. [Medline].

  3. Munchau A, Bronstein AM. Role of the vestibular system in the pathophysiology of spasmodic torticollis. J Neurol Neurosurg Psychiatry. Sep 2001;71(3):285-8. [Medline].

  4. Munchau A, Corna S, Gresty MA, et al. Abnormal interaction between vestibular and voluntary head control in patients with spasmodic torticollis. Brain. Jan 2001;124(Pt 1):47-59. [Medline].

  5. Hummel P, Fortado D. Impacting infant head shapes. Adv Neonatal Care. Dec 2005;5(6):329-40. [Medline].

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  7. Do TT. Congenital muscular torticollis: current concepts and review of treatment. Curr Opin Pediatr. Feb 2006;18(1):26-9. [Medline].

  8. Morrison DL, MacEwen GD. Congenital muscular torticollis: observations regarding clinical findings, associated conditions, and results of treatment. J Pediatr Orthop. 1982;2(5):500-5. [Medline].

  9. Chen MM, Chang HC, Hsieh CF, et al. Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography. Arch Phys Med Rehabil. Nov 2005;86(11):2199-203. [Medline].

  10. Dudkiewicz I, Ganel A, Blankstein A. Congenital muscular torticollis in infants: ultrasound-assisted diagnosis and evaluation. J Pediatr Orthop. Nov-Dec 2005;25(6):812-4. [Medline].

  11. Parikh SN, Crawford AH, Choudhury S. Magnetic resonance imaging in the evaluation of infantile torticollis. Orthopedics. May 2004;27(5):509-15. [Medline].

  12. Celayir AC. Congenital muscular torticollis: early and intensive treatment is critical. A prospective study. Pediatr Int. Oct 2000;42(5):504-7. [Medline].

  13. Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am. May 2001;83-A(5):679-87. [Medline].

  14. Tatli B, Aydinli N, Caliskan M, et al. Congenital muscular torticollis: evaluation and classification. Pediatr Neurol. Jan 2006;34(1):41-4. [Medline].

  15. Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults. Neurology. Sep 26 2006;67(6):1083-5. [Medline].

  16. Opherk C, Gruber C, Steude U, et al. Successful bilateral pallidal stimulation for Meige syndrome and spasmodic torticollis. Neurology. Feb 28 2006;66(4):E14. [Medline].

  17. Sonmez K, Turkyilmaz Z, Demirogullari B, et al. Congenital muscular torticollis in children. ORL J Otorhinolaryngol Relat Spec. 2005;67(6):344-7. [Medline].

  18. Wei JL, Schwartz KM, Weaver AL, Orvidas LJ. Pseudotumor of infancy and congenital muscular torticollis: 170 cases. Laryngoscope. Apr 2001;111(4 Pt 1):688-95. [Medline].

  19. Sasaki S, Yamamoto Y, Sugihara T, Kawashima K, Nohira K. Endoscopic tenotomy of the sternocleidomastoid muscle: new method for surgical correction of muscular torticollis. Plast Reconstr Surg. Apr 2000;105(5):1764-7. [Medline].

  20. Cheng JC, Tang SP, Chen TM, Wong MW, Wong EM. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants--a study of 1,086 cases. J Pediatr Surg. Jul 2000;35(7):1091-6. [Medline].

  21. Shim JS, Noh KC, Park SJ. Treatment of congenital muscular torticollis in patients older than 8 years. J Pediatr Orthop. Nov-Dec 2004;24(6):683-8. [Medline].

  22. van Vlimmeren LA, Helders PJ, van Adrichem LN, Engelbert RH. Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil. Jan-Mar 2006;9(1):40-6. [Medline].

  23. de Chalain TM, Park S. Torticollis associated with positional plagiocephaly: a growing epidemic. J Craniofac Surg. May 2005;16(3):411-8. [Medline].

  24. Chate RA. Facial scoliosis from sternocleidomastoid torticollis: long-term postoperative evaluation. Br J Oral Maxillofac Surg. Oct 2005;43(5):428-34. [Medline].

 
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Appearance of torticollis as a result of sternomastoid fibrosis in a young child.
Surgical view of sternomastoid fibrosis shows the thyroid gland (1), the inferior thyroid artery (2), fibrosis of the sternal part of the sternocleidomastoid muscle (3), the brachiocephalic trunk (4), and the normal clavicular part of the sternocleidomastoid muscle (5).
 
 
 
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