Torticollis, also known as wry neck, is a condition where a baby’s head tilts to one side and the chin rotates to the other. Parents can get really worried with this, but with timely diagnosis and treatment, most cases of torticollis resolve without lasting complications.
What are the causes of Torticollis in newborns?
There are two main types of torticollis:
- Congenital Muscular Torticollis: This is the most common type, affecting about 1-2 babies per 1,000 births. The exact cause is unknown, but it's believed to be related to a tightened or shortened sternocleidomastoid (SCM) muscle in the neck. This muscle helps turn the head and can become tight due to positioning in the womb or trauma during birth.
- Acquired Torticollis : This less common type can develop after birth due to various factors, such as infections, injuries to the neck muscles, or problems with the spine.
How to recognize the signs of Torticollis?
These are some signs that might indicate your baby has torticollis:
- Head tilt : The baby consistently tilts the head to one side, with the chin facing the opposite direction.
- Limited neck movement : The baby has difficulty turning the head to one side.
- Facial asymmetry: The tightened muscle can cause one side of the face to appear flatter than the other.
- A lump in the neck : A noticeable lump may be present on the tightened SCM muscle.
When is surgery recommended?
While physical therapy and stretching exercises are the mainstay of treatment for torticollis in children, in some cases, surgery might be necessary.
What are the common surgical procedures for Torticollis:
The most common surgical procedure for torticollis in children is a release of the sternocleidomastoid (SCM) muscle from its one or both the bony attachments. This involves a small incision in the neck and a careful release of the shortened muscle fibers. In some cases, the shortened SCM muscle can be lengthened by ‘z’ plasty. In other cases the overacting SCM can be selectively denervated. In some cases additional procedures might be necessary:
- Release of fascial contractures : If the tightened muscle has caused surrounding tissues to become rigid (fascial contractures), these may also need to be released during surgery.
- Accessory muscle procedures: In rare cases, accessory neck muscles contributing to the head tilt might require intervention.
On what basis is surgery determined?
The decision to proceed with surgery for torticollis is made on a case-by-case basis, considering several factors:
- Severity of the condition : The degree of head tilt, facial asymmetry, and limitations in neck movement all play a role in the decision-making process.
- Age of the child : Early intervention is generally preferred, but surgery can be performed safely on children of various ages.
- Risks and benefits : The potential benefits of improved head and neck mobility and reduced facial asymmetry are weighed against the risks associated with any surgery.
How does the child recover after surgery?
Torticollis surgery is generally a daycare procedure with a short recovery time. Post-surgical care usually involves neck immobilisation with a cervical collar. Physical therapy helps to maintain the improved neck mobility and prevents future tightening of the muscle.
With early diagnosis and proper treatment, most cases of torticollis resolve completely within a few months. In rare instances where treatment is delayed, complications like facial asymmetry or permanent head tilt may occur. However, these complications are usually mild and can be addressed with additional therapy or surgery in severe cases.