Congenital Torticollis and Plagiocephaly
CONGENITAL TORTICOLLIS
What is Congenital Torticollis?
Congenital torticollis is a condition affecting the sternocleidomastoid (SCM) muscle, either due to contracture, shortening, or inflammation in the muscular belly. It usually appears within the first two months of life. This muscle is located in the anterior and lateral area of the neck, and it manifests when the baby only turns the head to one side, often experiencing pain when trying to rotate it to the opposite side. It usually presents together with facial asymmetry and cranial flattening (plagiocephaly). The recovery prognosis for this condition is highly favorable; the earlier physiotherapy begins, the faster the results will be seen.
Causes of Congenital Torticollis
Although the causes have not been clinically confirmed, it is often linked to the baby’s position in the womb or possible overstretching of the muscle during birth.
Diagnosis of Congenital Torticollis
The diagnosis is symptomatic. Typically, one observes a lateral inclination of the baby’s head and a limitation in head rotation, with or without facial asymmetry or plagiocephaly, as well as changes in the muscle’s texture to the touch. In some cases, a muscular ultrasound may be necessary.
Complications of Congenital Torticollis
Most early-treated cases recover in a few weeks, leaving no after-effects. In more advanced cases, the following may occur:
- Plagiocephaly leads to an asymmetric positioning of the occipital condyles, which can be compensated by the appearance of vertebral scoliosis.
- The cranial asymmetry generates facial asymmetry. The size of the eye sockets may differ, causing asymmetric visual accommodation. This can lead to nearsightedness, farsightedness, or strabismus. The child may need glasses or optometric treatment.
- Facial asymmetry is also observed at the mandibular level. Typically, there is a torsion of the two hemimandibles, which can lead to dental occlusion problems (crossbite).
Medical Treatment for Congenital Torticollis
Early treatment by a specialized physiotherapist is recommended to ensure a successful recovery. This treatment involves regular monitoring and continuous evaluation of the progression of the condition. Parents are usually given a series of exercises and techniques by the therapist to perform at home, speeding up the recovery as much as possible.
In cases of severe plagiocephaly, the use of cranial orthoses has proven quite successful.
In more complicated cases (a small percentage overall), the doctor will evaluate the need for other treatment methods.
PLAGIOCEPHALY
Plagiocephaly is an asymmetric cranial deformity in infants. The main reason for plagiocephaly is postural. A baby’s head may become flattened on one side or the other due to the number of hours they spend lying in cribs or strollers when they are newborns.
Early treatment leads to rapid recovery since the cranial bones are more malleable in the first months of the baby’s life. It is often associated with congenital torticollis, which should be addressed first to correct the cranial deformity.
By taking a detailed history and examining the baby, a specialized physiotherapist can determine if there is any musculoskeletal cause behind the cranial deformity. Using manual techniques and positioning, both during sessions and at home, plagiocephaly is often corrected within a few months.
In more advanced cases, cranial orthoses are used to correct the cranial asymmetry.