What is Torticollis?

Congenital muscular torticollis is the name given to the appearance of the neck that appears at birth or shortly thereafter, where the head leans towards one shoulder. It is a disease that occurs most frequently in the neck muscles called sternocleiodomastoid (SCM) and is characterized by thickening and shortening of the muscles. Muscular torticollis is the most common and is usually seen as unilateral, 2-8% bilateral. It is seen slightly more frequently in male babies.

What Causes Torticollis?

The causes are not known for sure. However, although some theories have been put forward, they have not been proven for sure.

These are the abnormal position of the baby's head in the womb, birth trauma, circulatory disorders of the sternocleidomastoid muscle and bleeding into the muscle.

Cervical hemivertebra (missing half of the neck vertebra)
Acute fasciitis (inflammation of the membrane surrounding the muscles) and eye muscle imbalance
Venous occlusion (blockage in the vein) Neurological torticollis, Grisel syndrome (a disease in which the stability of the joint between the 1st and 2nd vertebrae is impaired as a result of trauma or inflammation.)

Sandifer syndrome (a disease in which reflux, torticollis, abnormal behavior and movements are observed)

How is Torticollis Diagnosed?

The diagnostic process begins with the suspicion of families and especially pediatricians. The child or baby's head is always turned to the same side. In children, a non-tender, hard mass may be palpable in the muscle on the side of the neck. Right-sided SCM muscle involvement is around 60%. Bilateral involvement occurs in 2-8%. It is usually noticed at 3-4 weeks of age. The head turns to the side of the lesion, and the face turns to the opposite side, i.e. the ear is pulled towards the collarbone on the side with torticollis, and the face looks up to the opposite side. Facial hypoplasia and asymmetry may be seen in delayed patients.

Are There Types of Torticollis?

Torticollis can generally be evaluated in three groups.

• The group with a mass detected in the neck; is the most common group. A mass of 1-3 cm in size on the SKM muscle is noticed during physical examination at birth. The mass is usually hard and mobile. It can be sensitive during manual examination. 50-70% of the mass disappears by the time the child is 6 months old, and about 10% disappears by the 12th month. However, if it is not treated regularly, the mass disappears, but the curvature in the neck and facial asymmetry become apparent.
• The group without a mass in the neck; no mass is detected during physical examination, there is tension in the SKM muscle. It is also called muscular torticollis. This group of patients in particular can be confused with neck curvature due to anomalies in the cervical spine bones, and care should be taken.
• Postural torticollis: There is no tumor or shortening in the SKM muscle. It improves within a few weeks. It is caused by intrauterine position anomalies. Neck curvature is not always seen, it is intermittent.

Are There Degrees of Torticollis?

Yes, there is. Torticollis is classified as mild (1-25 degrees), moderate (16-30 degrees), and severe (>30 degrees) according to the degree of head tilt.

Can Torticollis Be Confused with Other Diseases?

Other congenital musculoskeletal anomalies can be seen in 6-20% of patients with torticollis. In patients with torticollis, the presence of pathologies such as C1 and C2 bone (neck spine bone) anomalies, neck bones, spinal scoliosis, congenital muscle diseases, congenital anomalies of the hip bone should be investigated. The rate of hip dysplasia in patients with torticollis varies between 0-20%. Congenital muscular torticollis can be detected in 8% of patients with hip dysplasia.

How is Torticollis Treated?

There are two treatment approaches to torticollis. In these two approaches, the age of diagnosis and the degree of torticollis are important.

1- Conservative treatment

The basis of this treatment is exercise. The exercises are active and passive stretching exercises. In active exercises, in order to ensure that the baby moves to the affected side, it is necessary to lay the baby down so that the audible and light stimuli (such as toys) that attract the baby's attention are on this side. The child should be breastfed and fed by the patient. In order to prevent head and face deformity, the baby should be put to sleep by changing the right and left side. In this way, the baby is allowed to exercise with his own movement. In order to prevent the development of head deformity, the child should be put to sleep by changing the right and left side.

In addition, the family is taught passive exercises to be done at certain intervals daily. In these exercises, only the patient's neck needs to move, not the entire body. Therefore, the body needs to be fixed by the assistant or the person performing the exercise.

Passive stretching exercises are applied to the neck in the directions of flexion (forward movement of the neck), extension (backward movement of the neck), lateral flexion (bending to the right and left) and rotation (turning).

More than 90% of patients can recover in the first six months after birth with early diagnosis and stretching exercises, without surgery.

2- Surgical treatment

If torticollis continues in the 12-15th months despite physical therapy, if the shortness, tension in the SCM muscle and facial deformity are progressive, and if the diagnosis is made after the age of 1, surgery should be performed.

What Happens If Torticollis Is Not Treated Regularly?

In patients who are not operated on in a timely manner, flat head syndrome called plagiocephaly, disproportionate body growth called hemihypertrophy and spinal curvatures called scoliosis may occur.

If the tension in the SCM muscle in the neck continues after the sixth month, jaw, ear and eye problems (60-70%) may develop.

What are the Expected Benefits of the Procedure in Patients Whose Treatment Has Been Delayed and Who Undergo Surgery?

After the procedure, the curvature in the neck corrects itself, but the facial deformity either does not return to normal or it may take 15-20 years for it to return to normal.

What is the Success Rate of the Surgery?

The chance of success is quite high in children under the age of 4. However, it may be necessary to use a neck brace and do active and passive exercises for a certain period of time after the surgery. If these are done properly, the success rate is high.

What is Done Before Torticollis Surgery?

A good history should be taken first and a general physical examination should be performed. Then, the family (mother and father) should be well informed about the process, that is, before the surgery, during the surgery and after. If the child is older, the child is also included in this. A number of tests are performed, these tests are not general and are determined according to the patient. The patient is also seen by the anesthesiologist, the family and the child are informed about the anesthesia process that will be experienced. The patient is left hungry for 4 hours before the surgery.

What is the Recovery Process After Torticollis Surgery?

The patient is fed in accordance with the doctor and / or nurse's directions 2 hours after the surgery. After the surgery, the patient only takes painkillers in accordance with the doctor's recommendations, there is no need to take additional medication. He/she can be discharged 6 hours after the surgery. The patient is seen by the doctor 48-72 hours later, there is no need for dressing during this time, the stitches dissolve on their own and do not need to be removed. The patient continues his/her normal active life in accordance with the doctor's recommendations after the surgery. 10 days after the surgery, a neck brace is used and exercises are started. The duration of this varies from patient to patient, and is decided by the patient's physician.

Is a 2nd Surgery Necessary in Torticollis Surgeries?

Rarely, it may be necessary if insufficient release was made in the first surgery or if postoperative exercises were not done sufficiently.

What Risks Can Torticollis Surgeries Have?

Since the patient will receive general anesthesia during the surgery, there may be anesthesia risks, and the patient's relatives are informed about this by the anesthesiologist physician before the surgery. In addition, there may be some surgical complications (such as wound infection, bleeding, insufficient release and continuation of torticollis).

*** The information provided here and the content of the website have been prepared for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should lead to any decision or action. Families should definitely have their patients examined by a pediatric surgeon, consult with him/her and make a decision by consulting his/her personal information.