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PubMed2004

[3D-CT investigation of craniofacial and cervical spine anomalies in congenital muscular torticollis].

PURPOSE: To investigate the accompanied craniofacial and cervical spine anomalies in congenital muscular torticollis (CMT) with three-dimensional computerized tomography (3D-CT). MATERIALS AND METHODS: We examined six cases of CMT. Cranial and cervical 3D CT was performed in all cases. Facial midline deviation angle (FDA), upper hemifacial width, lower hemifacial width (LHFW), length of hemimandible and zygomatic arcus, posterior hemicranial width (PHCW), anterior hemicranial width and cranial base midline deviation angle (CBDA) were measured on cranial 3D-CT images. Value of orbital index was calculated. Data achieved both ipsilaterally and contralaterally were compared with paired t-test. Atlanto-axial rotation angle (AARA) and atlantodental interval (ADI) values were measured on cervical 3D-CT images. RESULTS: Ages ranged between 2-26 years with a M/F ratio of 1/5. Facial asymmetry was diagnosed in all cases and LHFW was significantly undersized when compared to contralateral side (p < 0.05). FDA was measured 5.4+/-2.0 degrees on the average. Zygomatic arcus and hemimandible were significantly undersized on the side of torticollis (p < 0.05). Occipital plagiocephaly existed in all cases and PHCW was significantly extensive on torticollis side (p < 0.05). CBDA was measured 4.5+/-1.7 degrees on the average. Rotational movement of atlas over axis was observed in all cases where the AARA was 15.0+/-7.4 degrees. ADI was lesser than 3 mm in all cases. CONCLUSION: Even occipital plagiocephaly, maxillary and orbital deformity were commonly found in cases of CMT, most dominant asymmetry was observed in lower hemifacial region, zygomatic arcus and mandible by 3D-CT imaging. Rotational movement of first cervical vertebra over the second one was determined in all cases.

Adolescent↗
PubMed2006

Benign paroxysmal torticollis of infancy. A case report.

Benign paroxysmal torticollis of infancy is a benign, rare, probably under-recognised disorder, characterized by recurrent episodes of head tilting. The diagnosis is primarily one of pattern recognition and exclusion of alternatives conditions; other symptoms, such as vomiting, pallor and eyes' rotation, may be associated with or rapidly follow the attack, leading to misdiagnosis of this disease. The exact pathogenesis of benign paroxysmal torticollis is not clear, but a close relationship with childhood periodic syndromes is supposed. Due to the difficulty in defining the disease, this event has implications with respect to the training and education of practice providers and emergency physicians. We describe the case of a 7-month-old infant with benign paroxysmal torticollis recently observed, discuss the clinical presentation and review the literature.

Female↗
PubMed1991

[Spinal epidural abscess as the cause of torticollis--diagnosis by magnetic resonance imaging].

Spinal epidural abscesses are rare, accounting for only 0.2-1.2 of every 10,000 hospital admissions. Because they often present with non-specific symptoms, they are frequently misdiagnosed. We present a case in which superconduction MRI was used to make the diagnosis and to follow the clinical course of a spinal epidural abscess. In December 1988, a 33-year-old male developed spiking fever and the sudden onset of torticollis. He had had a cerebral palsy from birth, with chronic tetraparesis and mental retardation. Isolation of staphylococcus aureus in urine and blood cultures confirmed the diagnosis of pyelonephritis and septicemia. A high fever persisted despite antibiotic therapy commenced immediately. A technetium 99 m scan showed a localized uptake of isotope in the cervical spine. An MRI examination performed in the following day under sedation showed a mass with the same signal intensity as muscle on T1-weighted images. It was located behind the vertebral bodies C1-Th1 compressing the spinal cord. In addition, a lesion with a decreased signal was also evident in the C5-C6 vertebral bodies. Because of torticollis, the patient was unable to keep his head still for a sufficient period of time, to obtain T2-weighted imaging. The MRI findings indicated the presence of a spinal epidural abscess and osteomyelitis. A second MRI done one month after admission showed a reduction in the size of the epidural mass, but further diminishing of the signal intensity of the vertebral lesion. One month later, the patient underwent the surgical removal of the pus and inflammatory soft tissue, and anterior fusion. The torticollis resolved following the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1990

[Torticollis as an initial symptom of adult-onset dystonia musculorum deformans].

Dystonia musculorum deformans (DMD) is an idiopathic movement disorder which usually involves pediatric age group and progresses to the generalized type. On the contrary in adult-onset DMD, dystonia is usually confined to an upper extremity and its clinical course is benign. The authors report seven patients with adult-onset DMD whose initial symptom was confined to the neck. Diagnosis of idiopathic spasmodic torticollis had been made in all of them. Average ages at the onsets of torticollis and extranuchal dystonia were 49 +/- 13 and 54 +/- 9 years (mean +/- SD) respectively. The duration between these onsets was 2-3 years in five patients and 10-17 years in two younger patients. Two patients finally developed generalized dystonia and one patient became hemidystonic type. These findings suggest that some patients diagnosed as idiopathic spasmodic torticollis are in an early stage of DMD and that this particular type progresses more likely to the generalized form than other types of adult-onset DMD.

Adult↗
PubMed1990

[Torticollis in children: do not forget the Sandifer syndrome].

We report a case of Sandifer syndrome with chronic torticollis and gastroesophageal reflux (GER). The infant exhibited regurgitations and vomiting from birth. Torticollis with a permanent tilt of the head towards the right developed at age six months. At 16 months, persistence of the vomiting and abnormal attitude of the head and neck led to a CT scan that outruled a brain tumor. Esophageal pH recordings disclosed severe gastroesophageal reflux (pH less than 4 for 46% of the time over 24 hours) and endoscopy showed ulcerated peptic esophagitis. Surgical treatment of the GER ensured both resolution of the reflux and disappearance of the torticollis, establishing the causal relationship between the former and latter manifestations.

Female↗
PubMed1989

[Neck pain and isolated torticollis revealing neurologic lesions].

Neck pain and torticollis are very common symptoms, but they may reveal an intracranial or cervical neurological disease. Such diseases are easily diagnosed when these two symptoms are associated with others, but in some rare cases, and especially when it is isolated, torticollis may be mistaken for common neck pain. This is what happened in 21 cases and in some patients the neurological disease had been present for a very long time before it was diagnosed. Prior to admission, most patients were treated with massages, cervical collar or manipulations which sometimes resulted in deterioration. A search for atypical features of neck pain and torticollis should avoid delays in diagnosis.

Adult↗
PubMed1989

Torticollis.

Torticollis can be an isolated deformity or a sign of other neuromuscular disease. Underlying central nervous system or infectious disorders need to be considered and treated. In most patients, an improvement in the aesthetic disability is the primary objective. In general, an operation is indicated for the classical "congenital" muscular torticollis that does not respond to physiotherapy and forceful stretching of the restricting neck band. The mass or "tumor" of "congenital" torticollis requires no specific treatment. Operation may be delayed until age 1, but should probably be completed prior to school age. Reversal of craniofacial asymmetry is best achieved at an early age when there is maximum growth potential. Principles of surgery are (1) identification and release of all restricting bands involving the sternocleidomastoid muscle and other neck structures, (2) moving of the head and neck through a full range of motion prior to the completion of the procedure, and (3) resumption of physical therapy within 2 weeks of operation to prevent recurrent scar contracture. Various operations have been recommended, the most popular and reliable being inferior open tenotomy of the sternal and clavicular heads of the sternocleidomastoid muscle. Incisions should be placed low in the neck along skin lines and not over the clavicle in order to avoid hypertrophic scarring. Other procedures discussed are superior open sternocleidomastoid tenotomy (mastoid release), muscle lengthening procedures, and sternocleidomastoid excision. Only modest results should be anticipated in older children or adults with long-standing disease or advanced craniofacial asymmetry.

Humans↗
PubMed1988

An apparatus for a complimentary treatment of spasmodic torticollis.

We have developed an apparatus for treating spasmodic torticollis that can be used at home both during intensive therapy and follow-up. The refractoriness of spasmodic torticollis requires patients to practice biofeedback training partly on a home basis. However, it is usually difficult for spasmodic torticollis patients to provide and handle electromyographic (EMG) biofeedback training instruments. The present apparatus has 2 parts: first, a harness with a light source which is fixed on both shoulders; second, a photoreceptor, operant system for rewarding effect, and a digital recorder. The light is adjusted to strike the photoreceptor on the forehead when headposition is normal. Subjects are asked to keep the operant system--e.g. a radio--activated. They are trained in various postures as sitting, standing and walking. This apparatus provides a chance of home training to augment and maintain the effect during therapeutic sessions and the follow-up period.

Biofeedback, Psychology↗
PubMed1986

[Phenomenon of inverted rotation in spastic torticollis].

The article describes a rare clinical case where a patient with right-side spastic torticollis developed stable left-side spastic torticollis following discontinuation of nacom. On the basis of clinico-physiological analysis of the given phenomenon and having compared their findings with the literature data the authors substantiate the involvement of the nigrostriatal systems of both hemispheres in the pathogenesis of torticollis and in the mechanisms of rotation inversion reported in the given disease for the first time.

Adult↗
PubMed1986

Torticollis in children caused by congenital anomalies of the atlas.

Hemi-atlas is a rare congenital anomaly in the formation of the first cervical vertebra. It may cause a rather severe and progressive torticollis. When a child is young, the neck, despite the deformity, is flexible and the torticollis can be passively corrected. However, in some patients it becomes increasingly severe and fixed. I describe the findings in seventeen patients, seven of whom were operated on between 1975 and 1983. Treatment with a brace was shown to be ineffective. In patients with severe deformities, fusion of the upper part of the cervical spine is recommended. Fusion was obtained in all seven patients in whom it was attempted, and there was good postural correction in all. Early operation is recommended if the deformity is increasing. Gradual correction in a halo cast followed by posterior fusion is recommended as the treatment of choice in patients with severe torticollis.

Adolescent↗
PubMed1985

Torticollis: a review of etiology, pathology, diagnosis and treatment.

A literature review of the etiology and pathology of torticollis has been undertaken from which six classifications are suggested and discussed. Evidence is presented that the neuromuscular control mechanisms pertinent to the cervical spine are vulnerable at various levels and that a specific etiology of torticollis is yet to be identified. A brief discussion of the diagnosis and treatment of torticollis is presented.

Cervical Vertebrae↗
PubMed1977

Paralysis of the trapezius associated with myogenic torticollis. A report of 6 cases.

The authors report the follow-up results of forty-three patients operated on for myogenic torticollis between 1965 and 1975. The surgical treatment consisted of distal tenotomy in eight cases, distal and proximal tenotomy in twenty-three cases, tenomyomectomy in eight cases. The results were subdivided into three groups: excellent twenty-two, (57 per cent); good , fourteen (38 per cent); poor, two (five per cent). The most interesting finding that emerged was the association of paralysis of the trapezius muscle with myogenic torticollis: this was observed in six cases, three after and three before operation. Preoperative investigations, including an EMG test and confirmation at operation, appeared to show that the paralysis was secondary to compression of the accessory nerve in its passage through the sternocleidomastoid muscle. Neurolysis, performed in three cases, led to recovery of the paralysis. Compression of the accessory nerve is slowly progressive, and paralysis or paresis of the trapezius muscle therefore occurred late. In fact, the patients who presented with both lesions were well beyond infancy. The authors emphasize the importance of being aware of the association of this lesion with myogenic torticollis so that operation for the latter may complemented by neurolysis of the accessory nerve.

Accessory Nerve↗
PubMed1982

Torticollis and serendipity.

Spasmodic torticollis is often a severely disabling disorder which can be extremely resistant to any form of treatment including newer methods employing electromyographic biofeedback. This case study describes the diagnostic and treatment methods utilized with a 63-year-old woman with a 6-month history of spasmodic torticollis. Several treatment approaches were attempted, including biofeedback, relaxation training, and a combination fading desensitization approach. All corrective measures were unsuccessful until serendipitous circumstances suggested a treatment employing both a particular movement pattern that relieved the problem in the total behavior chain associated with spasmodic torticollis.

Anxiety↗
PubMed1982

Congenital muscular torticollis. A long-term follow-up.

Fifty-seven patients with congenital muscular torticollis who were treated between 1941 and 1977 were evaluated after an average follow-up of 18.9 years. We found that if congenital muscular torticollis persisted beyond the age of one year, it did not resolve spontaneously. Children with torticollis who were treated during the first year of life had better results than those treated later, and an exercise program was more likely to be successful when the restriction of motion was less than 30 degrees and there was no facial asymmetry or the facial asymmetry was noted only by the examiner. Non-operative therapy after the age of one year was rarely successful. Regardless of the type of treatment, established facial asymmetry and limitation of motion of more than 30 degrees at the beginning of treatment usually precluded a good result. While these fifty-seven patients had little functional abnormality at follow-up (some of those with a persistent head tilt had mild, asymptomatic compensatory scoliosis), noticeable cosmetic deformity was present in approximately 31 per cent of the patients.

Adolescent↗
PubMed1982

Congenital muscular torticollis: observations regarding clinical findings, associated conditions, and results of treatment.

Of the 232 patients with a diagnosis of congenital muscular torticollis, more than one-half were initially revealed before 3 weeks of age. The most common presentation at the initial clinical evaluation was head tilt. A surprisingly high incidence of associated conditions including hip dysplasia and lower extremity changes was seen. As a consequence all patients with a diagnosis of congenital muscular torticollis underwent a careful clinical review and roentgenographic examination of the entire spine and hips. Good or excellent results were achieved in all children diagnosed and treated under 1 year of age utilizing conservative measures. In the older child satisfactory results were seen for the primarily cosmetic deformity when surgically approached using an open distal myectomy. There appears to be no justification for a surgical approach in the child with congenital muscular torticollis under 1 year of age.

Age Factors↗
PubMed1995

[Subgroups of torticollis spasmodicus from the psychosomatic viewpoint. Results of a cluster analysis of 144 cases. German Study Group of Dystonia Research].

The question of subgroups in idiopathic spasmodic torticollis, which has been discussed in earlier studies in order to define etiologically heterogeneous patient populations has lost some of its relevance since with the injection of botulinum toxin an effective treatment is available. However, psychosocial distress is linked with spasmodic torticollis in a substantial number of patients. In order to define criteria for psychosocial interventions in addition to the treatment with botulinum toxin, a cluster analysis was carried out to identify high-risk populations in terms of psychological and social distress. Five subgroups were defined on the basis of eight variables. Two of these five groups, one group with rotational torticollis and one with laterocollis, emerged as particularly distressed by their physical complaints, the effects of their illness on various areas of life and in terms of psychological functioning. The consistency of the subgroups was tested and statistically confirmed by analysis of variance. In a cross-validation 83.02% of the ungrouped cases were predicted correctly. The authors suggest that the evaluation of psychological and social aspects of the condition should be part of the neurological assessment in order to offer appropriate support to patients, who reveal a high degree of psychological distress.

Adaptation, Psychological↗
PubMed1995

Surgical correction of muscular torticollis in older children.

BACKGROUND: Children with muscular torticollis treated before the age of 1 year respond well to conservative treatment. Surgical correction is indicated only in resistant cases. Nevertheless, there is still controversy about the results and the type of operation in the management of neglected older children. METHODS: Seventeen patients, at a mean age of 9 years and 5 months, with muscular torticollis were surgically treated between 1986 to 1991. The average follow-up period was 3 years and 4 months. months. Combined approach with open tenotomy at mastoid and clavicular level was the choice of procedure. The outcome for these older children and young adults were evaluated with function and cosmesis. RESULTS: Our results showed that the best results can be expected in children before 12 years of age. Late releases give acceptable results, although facial asymmetry and some residual upper dorsal scoliosis remain. Adequate surgical release and intensive postoperative physical therapy are the keystones to a good result. CONCLUSIONS: Surgical correction of muscular torticollis in the older children is of benefit for functional and cosmetic recovery, but facial asymmetry is irreversible after 12 years of age.

Adolescent↗
PubMed1993

[Spastic torticollis in children (the problems of the clinical picture, treatment and nosological specificity)].

Twenty-two cases with spastic torticollis in children are analyzed. This syndrome was the only suffering in ten children and was a component of generalized forms of deforming muscular dystonia in twelve. In such cases the time course of spastic torticollis clinical picture, possible alteration of tonic and clinical forms, involvement as a rule of hands and shoulders muscles permit regarding this condition as a variant of local deforming muscular dystonia and not an individual hyperkinesis. The efficacy of routine drug therapy administered to these patients directly depended on the form and pattern of spastic torticollis. Positive shifts were observed in 90.9% of patients, in 40.9% a marked positive effect was attained.

Adolescent↗