Torticollis- Wry neck

A torticollis is characterised by a typical head tilt due to a tonic component. There are many anatomical forms of torticollis depending on the group of neck muscles involved…

Laterocollis, the most common variant seen – in which the head is displaced with the ear moved toward the shoulder from increased tone in the ipsilateral cervical muscles.

Rotational torticollis -partial rotation or torsion of the head occurs along the longitudinal axis

Anterocollis – the head and neck are held in forward flexion with increased tone of anterior cervical muscles

Retrocollis -the head and neck are held in hyperextension with increased tone in the posterior cervical muscles.

Acute torticollis can be the result of ..

Blunt trauma to head and neck
Sleeping in an awkward position.
Result of idiosyncrasy to certain medications (eg, traditional dopamine receptor blockers, metoclopramide, phenytoin, or carbamazepine.)
Upper respiratory and soft-tissue infections of the neck can cause an inflammatory torticollis secondary to muscle contracture or adenitis
Atlantoaxial rotary subluxation (AARS) of C1 on C2 esp in children- can occur after minor trauma, pharyngeal surgeries-retropharyngeal edema leads to laxity of ligaments and structures at the atlantoaxial level, permitting the rotational deformity. In AARS, the head tilts away from the affected SCM muscle. Known as the “cock robin” position, the head is rotated to the side opposite the facet dislocation and laterally flexed in the opposite direction
Pediatric compensatory etiologies resulting in torticollis may include:
- Strabismus with fourth cranial nerve paresis
- Congenital nystagmus
- Posterior fossa tumor

MANAGEMENT

Medications-