Torticollis

Question 1

Describe physical manifestations of Torticollis?

Answer 1

Head tilt toward affected side
Rotation of chin away from affected side
Palpable mass or fibrous cord in SCM
Restricted active and passive ROM

Long term findings- plagiocephaly, craniofacial asymmetry, scoliosis

Question 2

First line treatment for torticollis?

Answer 2

Physio referral and program of active positioning(tummy time, change sides of change table) and passive stretch.

100% effective before 3 months, 75% after 3 months.

Consider bracing, Botox as second line

Question 3

Indications for surgery in torticollis?

Answer 3

• no progress after 6 months
• greater than one year at presentation
• greater than 7 months with palpable SCM fibrosis
• hemifacial hypoplasia

Contraindications:
-non congenital muscular Torticollis (CMT)

Question 4

Describe procedure for torticollis?

Answer 4

Unipolar release- divide the sternal and clavicvular insertions through small collar incision
- release platysma and soft tissues

• release omohyoid and anterior scalene as necessary.

Bipolar release- additional incision with release of mastoid attachments.

Question 5

Complications of SCM release?

Answer 5

Scarrring
Loss of neck contour
Spinal accessory nerve injury
Recurrence
Bleeding 
Infection