Congenital muscular torticollis is a violation of the position of the head as a result of underdevelopment or damage to the cervical muscles. It begins to manifest itself from the 2-3 th week of the child’s life with an increasing thickening of the nodding muscle. With unilateral torticollis, the head tilts to the sick side and turns slightly to the healthy side with the face. With a double-sided torticollis (less common), the head is tilted back. Treatment of congenital muscular torticollis is carried out by an orthopedist. Of the conservative methods, massage, physical therapy, physiotherapy are actively used, according to indications – wearing a Trench collar. Surgical treatment consists in lengthening the sternocleidomastoid muscle on the side of the lesion.
Q68.0 Congenital deformity of the sternoclavicular-mastoid muscle
Congenital muscular torticollis is one of the varieties of torticollis, a group of conditions characterized by a change in the normal position of the head. With torticollis, the head tilts to the sick side and turns slightly to the healthy side of the face. With bilateral torticollis (less common), the patient’s head is deflected back. Congenital muscular torticollis is the third most common congenital pathology, accounts for 5-12% of the total number of malformations, is more common in girls.
Congenital muscular torticollis occurs due to shortening of the nodding muscle on the side of the lesion. The change in the length of the muscle may be due to its underdevelopment, birth trauma and some other factors. Shortening of the nodding muscle causes not only a change in the position of the head. A child suffering from congenital muscular torticollis develops changes in the skull, collarbones and spine. The main causes of congenital muscular torticollis:
- underdevelopment of the nodding muscle;
- rupture of muscle fibers caused by birth trauma;
- chronic muscle inflammation;
- insufficient blood supply to the muscle.
In addition, congenital muscular torticollis can develop as a result of a prolonged inclined position of the fetus, which creates favorable conditions for shortening the nodding muscle.
The head of a child with congenital muscular torticollis is tilted to the affected side and slightly forward, the face is moderately or slightly turned to the healthy side. The upper arm on the side of the lesion is raised, there is an asymmetry of the skull and face. When examined from behind, cervical scoliosis, asymmetry of the neck and head are revealed.
As a rule, congenital muscular torticollis is invisible in the first ten days of a child’s life. On 15-20 days, thickening and compaction appear in the middle or middle part of the nodding muscle. The changes are gradually increasing. Along with the progression of changes, the manifestations of congenital muscular torticollis become more pronounced.
In some patients aged 2 months to 1 year, the thickening and thickening of the nodding muscle disappears on its own, and the muscle becomes elastic again. In other patients, the pathology continues to progress, the elasticity of the muscle decreases, the muscle thickens, becomes thinner and lags behind in growth compared to the muscle on the opposite side.
Pathological changes in the muscle cause a violation of local metabolic processes, and metabolic disorders, in turn, cause further aggravation of the torticollis. A kind of vicious circle is formed, and by the age of 3-6 years of the child’s life, the neck deformity becomes even more pronounced.
The diagnosis of congenital muscular torticollis is made based on the results of an external examination. Radiography is performed to assess changes in the spine. In some cases, an MRI of the spine may be required. All changes are secondary, develop because the child’s body is trying to adapt to the pathological position of the neck, and disappear after healing.
Treatment is carried out by a pediatric orthopedist. Conservative and operative techniques can be used in the course of treatment. The choice of treatment method depends on the age of the child, the condition of the nodding muscle and the degree of deformation of the neck. Early initiation of treatment of congenital muscular torticollis allows you to completely eliminate the pathology without resorting to surgery. In the absence of treatment, a child with congenital muscular torticollis gradually develops an asymmetry of the skull, and with age, treatment becomes less effective.
Conservative therapy of congenital muscular torticollis begins in the maternity hospital. The child is laid in a special way (on a healthy side), fed so that he tries to turn the head in the affected direction, massage of the nodding muscles is prescribed.
Treatment continues after discharge from the hospital. The baby is prescribed special therapeutic gymnastics, massage is performed. The affected muscle is warmed up with a “Sollux” lamp or a heating pad. After the child turns 1.5-2 months, electrophoresis with potassium iodide is added to the list of therapeutic measures. Some children are shown wearing a special cap or a Trench collar.
Proper child care is of great importance. The baby can not be held vertically before the due date. When putting a child to bed, it is necessary to keep the head in the correct position (various bandages, special caps, sandbags, etc. are used). With the timely start of complex treatment, in most cases it is possible to achieve complete elimination of the torticollis before the child turns 5-6 months old.
The indication for surgical treatment in traumatology and orthopedics is considered to be the preservation of pronounced torticollis in a child over the age of 2 years. The operation is best performed after the patient turns 3 years old. Surgical treatment consists in lengthening the sternocleidomastoid muscle on the side of the lesion. In the postoperative period, a plaster cast is applied to the patient for up to 1.5 months. Within six months after the operation, the patient is shown wearing a special head holder, physiotherapy and physical therapy.
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