[Torticollis in children: diagnostic approach]

Area of Science:

• Neurology
• Pediatrics
• Otolaryngology

Background:

• Torticollis is characterized by abnormal head posture, involving ipsilateral tilt and contralateral rotation.
• Causes are diverse, ranging from muscular issues to traumatic, inflammatory, infectious, and neoplastic conditions.
• Non-muscular origins include ocular, otolaryngological (ORL), or digestive system problems.

Purpose of the Study:

• To outline the clinical presentation and diverse etiologies of torticollis.
• To differentiate between acute and chronic forms of torticollis for appropriate management.
• To highlight diagnostic approaches for identifying serious underlying causes of torticollis.

Main Methods:

• Clinical examination to assess head posture and identify potential causes.
• Systematic radiography for traumatic torticollis, with dynamic evaluation 15 days post-injury.
• Consideration of otolaryngological assessment for suspected septic torticollis.
• Advanced imaging like CT (TDM) or MRI (RMI) for recurrent or neurologically complex cases.

Main Results:

• Most torticollis cases are minor and resolvable with physical examination.
• Traumatic torticollis requires initial radiography and follow-up dynamic assessment.
• Septic torticollis warrants investigation for otolaryngological infections or spondylodiscitis.
• Chronic torticollis may stem from congenital, postural, or malformative origins.
• Tumoral conditions necessitate advanced imaging (TDM/RMI) in specific clinical scenarios.

Conclusions:

• A comprehensive physical examination is crucial for initial torticollis assessment.
• Distinguishing between acute and chronic presentations guides diagnostic pathways.
• Advanced imaging is essential for ruling out serious pathologies like tumors in complex torticollis cases.