TorticollisTorticollisUniversity of Sto. TomasUniversity of Sto. Tomas

Faculty of Medicine and SurgeryFaculty of Medicine and Surgery

Section C3 – 2010Section C3 – 2010

Pelino, Sharlene; Perez, Jan Ray Q.; Perez, Joel; Pineda, Pelino, Sharlene; Perez, Jan Ray Q.; Perez, Joel; Pineda, Czarina; Pineda, John Michael; Pingoy, Anna Katrina; Piodena, Czarina; Pineda, John Michael; Pingoy, Anna Katrina; Piodena, Romeo III; Pioquinto, FatimaRomeo III; Pioquinto, Fatima

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Torticollis Torticollis

• also known as “wryneck”• simply refers to a “twisted

neck”• congenital or acquired• etiology: unknown but birth

trauma is most frequently associated

3Beauchamp et. al.: Sabiston Textbook of Surgery, 18th edBrunicardi et. al.: Schwartz’s Principles of Surgery, 8th ed

TorticollisTorticollis

• lesion results from fibrosis of the sternocleidomastoid muscle

• mass can be palpated within the affected muscle

• Histologic findings: characterized by the deposition of collagen and fibroblasts around atrophied muscle cells

4Beauchamp et. al.: Sabiston Textbook of Surgery, 18th edBrunicardi et. al.: Schwartz’s Principles of Surgery, 8th ed

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Congenital Torticollis Congenital Torticollis

• typical onset: 4 to 6 weeks of age in an otherwise healthy infant

• presence of a lateral neck mass in infancy in association with rotation of the head toward the opposite side of the mass

• head is typically tilted toward the side of the affected muscle and rotated in the opposite direction

• Dx: Purely clinicalBeauchamp et. al.: Sabiston Textbook of Surgery, 18th edBrunicardi et. al.: Schwartz’s Principles of Surgery, 8th ed

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Congenital vs. AcquiredCongenital vs. Acquired

Congenital TorticollisCongenital Torticollis• Onset: Within weeks

after birth (4-6 weeks)• Associated problems:

Rare

Acquired TorticollisAcquired Torticollis• Onset: Occurs later in life• Associated problems:

– Neurogenic:– Inflammatory: acute

myositis; infectious causes such as retropharyngeal abscess, cervical adenitis, or tonsillitis.

– Neoplastic: brainstem tumors

– atlantoaxial subluxation

8Beauchamp et. al.: Sabiston Textbook of Surgery, 18th edBrunicardi et. al.: Schwartz’s Principles of Surgery, 8th ed

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TreatmentTreatment

• Conservative• Physical therapy– Range-of-motion exercises

consist of passive stretching of the affected muscle

– Curative in most infants– Average duration of

required treatment - 4.7 months

10Beauchamp et. al.: Sabiston Textbook of Surgery, 18th edBrunicardi et. al.: Schwartz’s Principles of Surgery, 8th ed

TreatmentTreatment

• Surgical Resection/Transection of the involved muscles– rarely necessary– Indication: if symptoms

persist beyond 1 year

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TorticollisTorticollisUniversity of Sto. TomasUniversity of Sto. Tomas

Faculty of Medicine and SurgeryFaculty of Medicine and Surgery

Section C3 – 2010Section C3 – 2010

Pelino, Sharlene; Perez, Jan Ray Q.; Perez, Joel; Pineda, Pelino, Sharlene; Perez, Jan Ray Q.; Perez, Joel; Pineda, Czarina; Pineda, John Michael; Pingoy, Anna Katrina; Piodena, Czarina; Pineda, John Michael; Pingoy, Anna Katrina; Piodena, Romeo III; Pioquinto, FatimaRomeo III; Pioquinto, Fatima

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