Congenital muscular torticollis

Synonyms: Torticollis, congenital muscular torticollis

English: wry neck, loxia

definition

Of the Torticollis is a general term for a disease that ultimately becomes a Tilted head results. A distinction is made between different forms of torticollis, which have different causes and symptoms.
A rough subdivision is made according to whether the torticollis congenital or acquired is. The focus of this article is on the clinical picture of congenital muscular torticollis.

The innate muscular torticollis has an innate one Malformation of a specific muscle as a basis and is therefore a disease that often manifests itself in the newborn. In medical terminology, the congenital muscular torticollis is called congenital (innate) muscular torticollis (Torticollis).

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causes

Dem congenital muscular torticollis is a malformation of the Sternocleidomastoid muscle underlying. This muscle lies on the surface of the neck and can be easily felt when the neck is tensed. To him comes the function of Head turn to. Man has one such muscle on each side of the neck. At contraction, i.e. tension of the muscle on one side, results in a rotation of the head to the opposite side. At pathological constant contraction the head therefore remains in a forced misalignment.

There are now different theories for what exactly is the cause of the malformation. The following is a list of the possible causes:

1. Birth trauma: One possible theory is that children having a long birth with a difficult course have suffered from a muscular torticollis more often. This can lead to excessive stretching of the muscle if the newborn's head is stretched during the long birth. It can too Tears in the muscle cause it to bleed into the muscle. Of the bruise leads to the muscle being remodeled. Connective tissue, not muscle tissue, is built in. This is called fibrotic change. This results in a shortened, fibrotically altered muscle. However, that is only one thesis. One cannot say for sure whether this is really the case.
2. Genetic predisposition: Another possible cause is a genetic predisposition for the development of a muscular torticollis. There are families in which conspicuously often Children are born with this malformation.
3. Compartment syndrome: The compartment syndrome is one muscular disorder, at the important Vessels and annoy be compressed (squeezed). The cause of this is swelling of the surrounding tissue. Is the fetus lying crooked in the birth canal and if the head in particular is trapped in a hyperextension or sideways position for a long time, symptoms very similar to the compartment syndrome occur. The tissue pressure in the area of ​​the opposite Sternocleidomastoid muscle rises and can become one Undersupply of bloodcause so-called ischemia. The injury to the muscle results here from a bruise or a buckling and not from a tear (see theory 1).
4. Breech position: A forced posture of the fetus in which not the head but the pool can lead to the appearance of a muscular torticollis.

Symptoms

The characteristic position of the head and neck ultimately results from a fibrous contracture. The muscle is thereby through the connective tissue change greatly shortened and thickened and can also be felt as such. The result is a misalignment of the head and neck forward and to the side of the shortened muscle are inclined. However, the face is tilted to the other side. It can also lead to one on the sick side Shoulder elevation come. In severe cases, the short, thick muscle can be seen from the outside. It stands out as a thick strand under the skin from. Some of the symptoms can already be pronounced in the newborn, but they usually only appear at the age of a few weeks on. The symptoms of the throat are often accompanied by other misalignments of the skeleton.

Secondary malformations

These other misalignments include the secondary malformationsthat can result from an untreated torticollis. It can happen that the Cervical spine adapts to the misalignment of the neck. The consequence is one Scoliosis (a misalignment of the spine). As a result of scoliosis, deeper muscles in the neck area may also shorten. Because babies tend to sleep on their stomachs with their faces turned to the sick side, in some cases one also manifests Facial scoliosis. Of the skull of the baby is still soft and malleable in the first months of life. By having a uneven pressure on the skull works, since the child is always on the sick side, the skull and face are deformed. On the sick side is that Cheek flattened, the Eye is crooked. The corners of the mouth and ears hang in a low position. The result is a clearly visible one Asymmetry of the facewhich is not only a cosmetic problem for the children.

therapy

There are different therapeutic approaches. However, there is agreement that with advanced disease very pronounced scoliosis the cervical spine one Operation unavoidable is. But in the best case scenario it shouldn't get that far.
If symptoms appear for the first time, the malposition is attempted with Stretching exercises and positioning to counteract. The baby is encouraged to turn his head in the other direction. The muscle becomes active through physiotherapy exercises stretched several times a week.

The torticollis should, however not fixed after a year have been is one surgery of necessity. This is where the muscle becomes cut at both ends and fixed with a splint for about 6 to 8 weeks. If facial asymmetry has already developed by then, it can no longer be remedied. With early treatment, however, there is a good chance that the neck will be tilted to be completely exhausted. The younger the patient and the earlier they begin physiotherapy and repositioning, the better the results.

Summary

Of the Torticollis is a collective term for a number of different misalignments of the neck with many possible causes. Of the congenital muscular torticollis is a congenital malformation of Sternocleidomastoid muscle (superficial neck muscle). The muscle is conditioned by various factors shortened and thickenedso that it no longer fulfills its function properly. It results Misalignments of the neck and headthat in severe cases with a Facial asymmetry and one Scoliosis of the cervical spine accompanied.
It should as quickly as possible a therapy can be initiated, which consists in removing the deformity Physiotherapy exercises and repositioning to mend. If this happens early enough, secondary misalignments such as scoliosis of the cervical spine can be prevented. If the misalignment persists after a year, it is a Surgery requiredthrough which the muscle is brought into its anatomically normal position.