Imaging of congenital torticollis in infants: a retrospective study of an institutional protocol

OBJECTIVE The authors' objectives in this study were to evaluate their institutional protocol and create recommendations for radiographic imaging in infants with torticollis, with or without plagiocephaly, based on a retrospective clinical analysis and literature review. METHODS A retrospective analysis was conducted to identify infants with torticollis who were evaluated by the craniofacial team. The following patients were identified: those who underwent imaging in the form of radiography, CT scanning, or MRI; those who had a secondary diagnosis or additional clinical finding as the indication for imaging; and those with persistent torticollis despite completion of recommended repositioning techniques and physical therapy (PT). RESULTS A total of 683 infants between the ages of 1 day and 335 days (mean age 141.6 days) were referred for management of torticollis. Initial imaging was performed in 48 patients, of whom 44 were identified as having a diagnosis other than torticollis or a significant clinical finding as the indication for imaging. The remaining 4 patients (0.6% of the torticollis population) underwent imaging and did not have an additional diagnosis or a significant clinical finding. There were no abnormal radiological findings in these patients. Of the 639 patients diagnosed with congenital torticollis who did not have a secondary diagnosis that required initial imaging, 99.2% (634 patients) achieved resolution of torticollis with recommended repositioning techniques and completion of PT and without radiography, CT, or MRI. CONCLUSIONS Within the limits of this retrospective study and supporting literature, the authors provide the following recommendations regarding radiographic imaging of infants with congenital torticollis. 1) Clinical examination is sufficient in the diagnosis of congenital torticollis in infants. Radiography, CT scanning, and MRI are not necessary. 2) In cases in which additional clinical or neurological findings are present, imaging may be recommended. 3) PT and repositioning techniques are the recommended treatment modalities for congenital torticollis. 4) Additional evaluations should be performed throughout the duration of PT to assess progress and response to therapy. 5) Imaging should be performed to rule out nonmuscular pathologies if torticollis persists after 1 year of treatment.