Torticollis
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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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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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