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Congenital muscular torticollis
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- Torticollis is an abnormal positioning of the head.
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- Head positioned in the
characteristic fashion:
- The head is tilted toward the affected side.
- The chin is turned away from the affected side.
- Because of this, the child appears to be looking up and to the side; the child looks away from the side that is affected by the problem.
- Parents usually notice that a baby will not look in
one particular direction.
- Neck mass on the affected
side:
- The mass is usually first noticed soon after birth, but sometimes may not be found until several weeks after birth, when the infant's neck begins to elongate.
- The mass is firm and not tender, and increases in size for several weeks, then begins to slowly disappear over several months.
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- Injury to the neck during the delivery process
- Intrauterine pressure on the neck due to positioning in the uterus (womb)
- Abnormalities of blood vessels and blood flow in the fetus
- These abnormalities result in the formation of a small scar inside the muscles of the neck. It is this scar that is felt as the neck "mass." The scar tissue prevents the muscle involved from working normally.
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- Diagnosis is made on the basis of physical examination and history; no tests are needed.
- However, because some children with this condition will also have other musculoskeletal problems, X-rays of other parts of the body may be required.
- If the neck mass fails to disappear, an ultrasound may help confirm that other problems are not present.
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- The mainstay of treatment is stimulating the infant to turn his/her head toward the affected side. This will stretch out the scar tissue in the involved muscle.
- Usually, this is accomplished by placing the baby in a crib with all the toys and bright objects on the affected side. This forces the infant to turn the head to look at the interesting things in his/her environment.
- Some range-of-motion and stretching exercises are sometimes also used.
- If done consistently, these interventions will work in nearly all affected babies.
- The small number of children in whom the condition persists past the first birthday, or in whom the loss of range-of-motion is profound, require surgery to remove the scar tissue and return full function to the affected muscle.
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- Most infants will do very well and have no future problems.
- A small number may later develop an impairment of their ability to tilt the head, a difference in the size and shape of the two sides of the neck, or a slight degree of scoliosis.
- The risk of these complications does not appear to be affected by the kind of treatments used (stretching versus surgery).
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- See your pediatrician immediately.
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