Unilateral epicanthal fold: diagnostic significance

The dysmorphologic evaluations of 56 children with torticollis and plagiocephaly were reviewed. Half of the children were referred because of the cranial asymmetry, and the remainder because of other structural defects or developmental delay. A unilateral epicanthal fold was present in 22 of 54 fully documented cases (41%). In 78% of these, the fold was ipsilateral to the area of occipital flatness. Because most infants are examined in an en face position, the presence of a unilateral epicanthal fold should prompt further investigation for a readily treatable torticollis.