Torticollis

Key points

Nonparoxysmal Torticollis

Congenital muscular torticollis

Caused by intrauterine or intrapartum injury

Develops in the first month, with a mass in stenocleidomastoid (SCM) and head tilting

May become a fibrous band with persistent contracture

10% have hip dysplasia

Fibromatosis colli (pseudotumour of SCM) - benign, self-limiting

Nonmuscular, soft tissue torticollis - due to oropharyngeal infection causing ligament laxity

Paroxysmal Torticollis

Benign paroxysmal torticollis - Unknown cause

Sandifer syndrome (due to GORD)

Management

Physiotherapy

Botox

Surgery if no progress after six months, treatment starts after one year, or significant contraction/mass at seven months - release of SCM at the sterno-calvicular heads +/- mastoid head end

Post-op physiotherapy

Good outcomes

References

Gundrathi J, Cunha B, Tiwari V, et al. Congenital Torticollis. [Updated 2024 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549778/

Tomczak KK, Rosman NP. Torticollis. J Child Neurol. 2013 Mar;28(3):365-78. doi: 10.1177/0883073812469294. Epub 2012 Dec 26. PMID: 23271760.