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Inflammatory torticollis in children
1Department of Otolaryngology-Head and Neck Surgery, UCLA School of Medicine.
Insights
Acute torticollis in children often stems from inflammatory conditions like infections. Prompt evaluation is crucial to identify causes and rule out serious issues such as atlantoaxial joint subluxation.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Pediatric Orthopedics
Background:
- Acute torticollis is a common presentation in pediatric emergency departments.
- It typically involves unilateral sternocleidomastoid muscle spasm, causing characteristic head posturing.
- The condition often arises from inflammatory processes affecting the neck.
Observation:
- A study reviewed 26 children with acute nontraumatic torticollis.
- Common causes identified included upper respiratory infections, sinusitis, otomastoiditis, cervical adenitis, and retropharyngeal abscesses.
- Four patients presented with inflammatory-induced subluxation of the atlantoaxial joint.
Findings:
- Otolaryngologic infections are frequent triggers of acute torticollis in children.
- Inflammatory processes can lead to complications like atlantoaxial joint instability.
- Imaging techniques like CT and MRI are valuable diagnostic tools.
Implications:
- Children with acute torticollis require thorough assessment for underlying otolaryngologic infections.
- Early diagnosis and management are essential to prevent complications.
- Imaging aids in identifying the cause and ruling out atlantoaxial joint subluxation.
Abstract:
Acute torticollis is commonly seen in the pediatric emergency department. It often results from an inflammatory process that irritates the cervical muscles, nerves, or vertebrae. Posturing of the head occurs with unilateral spasm of the sternocleidomastoid muscle such that the child will position the head with the occiput rotated to the affected side and the chin rotated to the contralateral side. We recently treated 26 children who presented to the emergency department with acute nontraumatic torticollis. The most common causes were upper respiratory infection, sinusitis, otomastoiditis, cervical adenitis, and retropharyngeal abscess or cellulitis. Four patients had subluxation of the atlantoaxial joint as a result of the inflammatory process. Children with acute torticollis need careful evaluation for either overt or occult otolaryngologic infections. Computed tomography and magnetic resonance imaging are helpful in determining the cause of the acute torticollis and in ruling out rotatory subluxation of the atlantoaxial joint.