Torticollis

  • a combined head tilt & rotatory deformity

Clinical

  • pain
  • vertigo
  • CSF obstruction
  • Myelopathy
  • Torticolis

Aetiology

Osseous types

  • Basilar impression – 15% present with  torticolis
    • Primary
      • related to vertebral defects e.g. Klippel Feil, occipital-atlanto fusion
    • Secondary
      • related to softening of the bone e.g. Osteogenesis Imperfecta, Achondroplasia, NF
    • nonoperative treatment of basilar impression is surgical via anterior decompression & fusion
  • Atlantooccipital
    • Occipital cervical synostosis
    • Basilar impression
    • Odontoid abnormality
  • Unilateral absence of C1
  • Famalial Cervical Dysplasia
  • Atlantoaxial Rotatory Displacement – see above

Muscular

  • Congenital Muscular Torticolis
    • Most common type in infant or small child
    • Theory is “compartment syndrome” of the sternocleidomastoid
    • Leads to head tilt & chin rotation
    • Frequently associated with DDH
    • Facial deformity may occur as the child grows
    • Stretching may or may not work – not contraindicated
    • Surgery – variable approach with unipolar or bipolar release & lengthening
  • Neurologic Type
    • Secondary to CNS tumor, syrinx, Arnold Chiari malformation etc
    • Secondary to opthamologic problem & this being positional
  • Sanifer Syndrome
    • GER & abnormal posture of the neck usually torticollis
    • Usually infant with CP
    • Get upper GI studies