Imaging Studies

Although the diagnosis of pediatric torticollis is easily made upon physical examination by an experienced clinician, ultrasonography (US) is the most commonly ordered test.^{[15, 16]}

Magnetic resonance imaging (MRI) may be useful in patients with nonmuscular causes of torticollis; however, it is not recommended in asymptomatic patients with infantile torticollis.^[17]Evaluation of MRI results correlated with histopathology has demonstrated that if multiple or large low signal intensities that represent increased fibrosis and aberrant dense connective tissue within the sternocleidomastoid are noted, a surgical release should be considered.^[18]

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.

Treatment & Management

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Media Gallery

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

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Pediatric Torticollis Surgery Workup

Imaging Studies

Histologic Findings

References

Tables

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