Torticollis in Infants: Understanding and Addressing This Common Condition

Congenital muscular torticollis (CMT) is a common pediatric condition characterized by unilateral shortening of the sternocleidomastoid (SCM) muscle, resulting in a head tilt to one side with contralateral rotation. This article provides an in-depth review of the etiology, pathophysiology, clinical presentation, and preventive strategies for torticollis in infants, with references to recent research and clinical guidelines.

Etiology and Pathophysiology

CMT is primarily attributed to perinatal factors that lead to SCM muscle fibrosis. The following are key etiological factors:

1. Intrauterine Constraint:?Fetal positioning, particularly in cases of oligohydramnios or multiple gestations, can lead to mechanical compression of the SCM muscle, resulting in ischemia and subsequent fibrosis.

2. Birth Trauma:?Instrumental deliveries using forceps or vacuum extractors, as well as complicated vaginal deliveries, can result in direct trauma to the SCM muscle, causing hematoma formation and fibrosis.

3. Genetic Predisposition:?Although less common, genetic factors may contribute to the development of CMT. Studies have suggested a possible association with certain connective tissue disorders.

Clinical Presentation

The clinical manifestations of CMT typically become apparent within the first few weeks of life. Key signs and symptoms include:

- Head Tilt and Rotation:?A persistent tilt of the head to the affected side with chin rotation towards the contralateral shoulder.

- Palpable Mass:?In some infants, a firm, fibrous mass, often referred to as a "sternocleidomastoid tumor," may be palpable within the affected muscle.

- Facial Asymmetry and Plagiocephaly:?Prolonged head tilt can lead to craniofacial asymmetry and positional plagiocephaly, characterized by unilateral flattening of the occiput.

Diagnosis

Diagnosis of CMT is primarily clinical, based on a thorough history and physical examination. Key diagnostic steps include:

- Physical Examination:?Assessment of neck range of motion (ROM) and palpation of the SCM muscle to detect tightness or masses.

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Differential Diagnosis

When evaluating an infant with head tilt, it is crucial to consider and rule out other potential causes, including:

- Ocular Torticollis:?Resulting from ocular misalignment or other visual disturbances.

- Neurologic Torticollis:?Due to central nervous system lesions or peripheral nerve injuries.

- Skeletal Abnormalities:?These include congenital vertebral anomalies or Klippel-Feil syndrome.

Preventive Strategies

Preventive measures are essential to reduce the incidence and severity of CMT. Recommendations include:

1. Promoting Tummy Time:?Encouraging prone positioning while the infant is awake helps to strengthen neck and shoulder muscles, facilitating symmetrical muscle development.

2. Varying Head Positions:?Regularly alternating the infant's head position during sleep and feeding can help prevent unilateral muscle shortening and plagiocephaly .

3. Minimizing Prolonged Supine Positioning:?Avoiding extended periods in car seats, swings, and other devices that limit head movement is crucial for preventing positional deformities.

Conclusion

CMT is a common but manageable condition in infants, requiring early recognition and intervention to prevent long-term sequelae. Understanding the underlying etiology, clinical presentation, and preventive strategies is essential for healthcare professionals involved in the care of affected infants. Continued research and adherence to clinical guidelines will enhance outcomes for these patients.

References

1. Cheng, J.C.Y., et al. (2000). The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—a study of 1,086 cases. Journal of Pediatric Surgery, 35(7), 1091-1096.

2. Ho, C.L., et al. (1999). Ultrasonographic study of the neck in congenital muscular torticollis. Acta Radiologica, 40(5), 538-543.

3. Davids, J.R., et al. (1993). Congenital muscular torticollis: sequela of intrauterine or perinatal compartment syndrome. Journal of Pediatric Orthopaedics, 13(2), 141-147.

4. Emrah, S. (2018). Congenital muscular torticollis and associated risk factors in children. Turkish Journal of Pediatrics, 60(6), 697-702.

5. Shim, J.S., & Jang, H.P. (2008). Operative treatment of congenital tortic