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Infantile torticollis: a review of 624 cases
1Department of Orthopaedics and Traumatology, Faculty of Medicine, Chinese University of Hong Kong.
Insights
Infantile torticollis affects 1.3% of Chinese children, often linked to difficult births. Early conservative treatment yields high success rates, but severe cases may require surgery.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
- Musculoskeletal Disorders
Background:
- Infantile torticollis is a common musculoskeletal condition in infants.
- Understanding its incidence, risk factors, and presentation is crucial for effective management.
- Previous studies have varied in scope and focus regarding this condition.
Purpose of the Study:
- To determine the incidence and epidemiological characteristics of infantile torticollis in Chinese children.
- To analyze the association between obstetric factors and congenital anomalies with torticollis.
- To evaluate the effectiveness of conservative treatment and identify predictors for surgical intervention.
Main Methods:
- Retrospective review of 624 infantile torticollis cases over 7 years.
- Data collection included incidence, boy-to-girl ratio, obstetric history, and congenital anomalies.
- Classification of torticollis types (postural, sternomastoid tumor, muscular) and assessment of neck range of motion.
Main Results:
- Incidence was 1.3% in Chinese children, with a 3:2 boy-to-girl ratio.
- 62.2% of mothers reported difficult labor, breech, or C-section; 6.04% had congenital anomalies.
- 97% resolved with conservative treatment; severe muscular torticollis (>30 degrees rotation) predicted surgery.
Conclusions:
- Conservative management is highly effective for most infantile torticollis cases.
- Continuous follow-up is recommended, especially for cases progressing from sternomastoid tumor to muscular torticollis.
- Persistent mild craniofacial asymmetry can occur even after resolution.
Abstract:
We reviewed 624 cases of infantile torticollis in one centre over a period of 7 years. The incidence of torticollis was found to be 1.3% in Chinese children. Boy-to-girl ratio was 3:2. Obstetric histories of the mothers showed a total of 62.2% with difficult labour, breech deliveries, or caesarean section, and 6.04% had associated congenital anomalies. Of all the cases, 27.88% were found to be postural, 35.4% had torticollis that presented with sternomastoid tumor, and 36.7% presented with muscular torticollis alone. When limitation of neck range was considered, 36.7% had a passive rotation deficit > 15 degrees. In patients presenting in the early stages, 97% of all infantile torticollis cases resolved with conservative treatment, active stimulation, and a passive stretching program. For those responding to treatment, the mean treatment period was < 6 months for varying degrees of neck rotational deficit. Patients with cord-like muscular torticollis and a rotational > 30 degrees were more likely to need surgery. Presence of sternomastoid tumor alone was not found to increase the likelihood of surgery. Musculoskeletal sequelae after torticollis had resolved included intermittent head tilt and persistence of mild craniofacial asymmetry. We recommend continuous follow-up in cases of infantile torticollis, particularly in patients with progression of sternomastoid tumor to muscular torticollis.