TORTICOLLIS
Careful palpation of a mass within the side of the neck of a neonate may reveal it actually to be within the sternocleidomastoid muscle. Occasionally
palpation is inconclusive and ultrasonography is necessary to confirm that the mass is truly intra- and not extra-muscular. The dense area of fibrotic
tissue within the muscle is more properly termed fibromatosis colli; torticollis or “wry neck” refers to the resulting rotation of the child’s head.
Fibromatosis colli always prevents the involved sternocleidomastoid muscle from relaxing, allowing the infant to rotate his head 90° away from the
fibromatosis but not much past the midline toward the affected side. This condition was once thought to be due to damage to the muscle at the time of
vaginal delivery, but it actually has its origin prior to birth. No individual has exact bilateral facial symmetry; that is, the right and left sides of
any individual’s face are not exact mirror images, but a child with untreated fibromatosis colli may have exaggerated dissymmetry with true hemifacial
microsomia.
If adequately treated during infancy, fibromatosis colli will generally resolve completely. Treatment consists of positioning and physical therapy
delivered at home by the infant’s primary caregiver. Several times daily, the infant’s head should be rotated toward the side of the fibromatosis and held
for several seconds. This is not done forcefully, but just until slight resistance is met. The fibrotic area will slowly relax over several weeks, and
range of motion toward both sides will eventually equalize. In addition, the child should always be held, or positioned in a crib, seat or other device,
in such a manner that the affected muscle is toward the side on which activity within the room is taking place. As the child’s attention is drawn toward
the noise or motion taking place, he will naturally rotate his head in that direction, stretching the muscle and providing his own physical therapy.
Although the torticollis will generally resolve with exercises and positioning, significant hemifacial microsomia and other associated anomalies will not.
Surgery to divide the muscle is required only when the condition persists past 12-15 months, the affected muscle begins tightening, and plagiocephaly or
facial asymmetry begins to worsen.