Congenital torticollis in children

Introduction to congenital torticollis in children Congenital torticollis (congenitaltorticollis) generally refers to congenital muscular torticollis, a side of the sternocleidomastoid contracture caused by head to one side skewed. basic knowledge The proportion of the disease: the proportion of the disease in a specific group is 0.01% - 0.02% Susceptible people: children Mode of infection: non-infectious Complications: vasculitis

Congenital torticollis in children

(1) Causes of the disease

The direct cause of this disease is that the fibrosis of the sternocleidomastoid muscle causes contracture and shortening, but the real cause of this muscle fibrosis is still unclear. Possible factors are birth injury, ischemia, venous occlusion, poor intrauterine posture. , genetic, growth stagnation, infectious myositis, or a combination of multiple factors.

The changes of the sternocleidomastoid muscle are very similar to the pathological changes of the interstitial syndrome. It is almost certain that the lesion is related to the intrauterine environment. It often occurs in the primipara and breech position of the elderly. It is generally considered that the neck is twisted in the uterus. Intrauterine body position is limited until delivery, resulting in muscle ischemia, edema and fibrosis, resulting in contraction of the sternocleidomastoid muscle (SCM) from the sternum and clavicle.

There are also clues that due to the long-term compression of the accessory nerve, the fibrosis of the muscle is more severe. Due to intrauterine restriction, developmental hip dislocation, foot deformity, deformation of the auricle of the affected side and flattening of the same side are mentioned. Can explain the cause of congenital muscular torticollis.

Because the sternocleidomastoid muscle fibrosis gradually shrinks to the appearance of the torticollis, the cause of muscle fibrosis is not very clear. The earliest theory of obstruction of intramuscular venous return is that the complete closure of the arteries in the muscle can cause muscle necrosis or Atrophy without fibrosis, intramuscular bleeding, whether or not there is nerve damage at the same time does not occur muscle fibrosis, breech or forceps-producing newborns found in the relatively common muscle torticollis, and some people think that trauma caused Muscle fracture produces hematoma, which eventually leads to muscle fibrosis, but the microscopic examination of surgical specimens has never seen hemorrhage and hemosiderin, so it does not support the reaction of muscle fibrosis after trauma. The problem is that the breech is induced muscle. The factors of the torticollis or the muscular torticollis are the causes of abnormalities in the breech or intrauterine position. It is difficult to explain that 75% of the muscular torticollis is the right side; it can be seen in every 5 cases of muscular torticollis. 1 case of hip dysplasia, indicating that congenital factors are at work, although family history does not indicate a genetic predisposition, but there is a report of muscular torticollis occurring in identical eggs, Beijing Children's Hospital, 1955 ~ In 2003, a total of 41 cases were treated surgically.

(two) pathogenesis

The true cause of the torticollis is not clear, the following lesions can be seen:

1. Early lesions: The intrathoracic mass of the sternocleidomastoid is a soft fibroma. The microscopic tumor consists of dense fibrous tissue before treatment, without the residual of hemorrhage and hemosiderin.

2. Late lesions: The tumor has disappeared, and the muscle tissue is replaced by fibrous tissue and the apoptosis of muscle cells is increased under the microscope of the sternocleidomastoid muscle.

Congenital torticollis prevention in children

Most of the disease is congenital and there are no effective preventive measures. The most important clinical aspect is to make early detection, early diagnosis and early treatment to prevent further damage to the child.

Congenital torticollis complications in children Complications vasculitis

Congenital muscular torticollis was not effectively treated early, and facial deformities appeared after 2 years of age. Mainly manifested as facial asymmetry, the distance between the bilateral ocular extraocular corners to the mouth angle is asymmetrical, the distance on the affected side is shortened, and the healthy side is increased. The plane of the affected eye is lowered, because the eyes are not at the same level, and visual fatigue is likely to occur and vision loss occurs. The healthy side is round and full, and the affected side is narrow and flat. Compensatory scoliosis can occur in the cervical spine. In addition, asymmetry changes can occur in the entire face of the child, including the nose and ears.

Congenital torticollis symptoms in children Common symptoms Thoracic deformity progressive neck mass

The head of the child is skewed to the disease side, and the lower jaw is turned to the opposite side. It can exist after birth, but it usually appears 2 to 3 weeks after birth. At the time of palpation, it can be found in the affected side of the sternocleidomastoid muscle. The painful fusiform mass gradually enlarges as large as the adult's thumb at 2 to 4 weeks, then begins to retract and gradually disappears within 2 to 6 months. Most patients do not leave the torticollis; The segment is replaced by a fiber cord. The head is deflected to the affected side due to the contraction of the contracture muscle. The head and face may have secondary deformities due to abnormal positions. The side of the muscle is shortened, and the length of the affected side is shortened. The widening of the face may be due to gravity and the growth of the bone. The face is more asymmetrical and the lateral part is obviously hypertrophied. The distance between the lateral eye of the affected side and the angle of the mouth is shorter than that of the opposite side. The two eyes are not the same as the two ears. flat.

Pediatric congenital torticollis examination

General laboratory tests are normal.

Can do head, neck, X-ray examination to exclude diseases such as cervical deformity.

Diagnosis and diagnosis of congenital torticollis in children

diagnosis

Diagnosis can be based on the cause, symptoms and related tests.

Differential diagnosis

Should consider cervical deformity, cervical spine subluxation, lymphadenitis caused by unilateral neck infection, abnormal vision, bilateral muscle strength asymmetry, cervical spinal cord tumor and tendon caused by acquired torticollis and posture The torticollis, congenital muscular torticollis atypical or conservative treatment or pain in the neck should consider other rare causes of the torticollis.

1. Neurotic torticollis: such as posterior fossa tumor, A- malformation, syringomyelia and infant paroxysmal torticollis, each with motor dysfunction, abnormal reflex, elevated intracranial pressure or MRI showing decreased brain stem position In addition, neck movement is limited with pain, strabismus, nystagmus, extraocular muscle paralysis, muscle stiffness, excessive excitement, etc. are important signs of intracranial lesions.

Infant paroxysmal torticollis may be caused by vestibular dysfunction, the most common in girls, the oldest is 2 years old, the so-called bursts, from a few minutes to full-day attacks, in addition to the torticollis, may be accompanied by a torso tilt, The eyeball is skewed, and the more prominent is that the direction of the neck tilt can be changed. The disease may be caused by migraine caused by vestibular dysfunction. The disease can be self-healing without special treatment.

2. Inflammatory torticollis: shallow cervical lymphadenitis, deep vertebral osteomyelitis, intervertebral disc inflammation mainly manifested as cervical dysfunction, pain with systemic fever; cervical vertebral eosinophilic granuloma, osteoid osteoma; intervertebral disc Calcification; juvenile rheumatoid arthritis, erosive odontoid; neck 1 to 2 subluxation; and sandifer syndrome, the main manifestations of this syndrome are esophagogastric reflux, head and neck position abnormalities, sick children vomiting, weight loss, Recurrent respiratory infections can also be seen in the cerebral palsy. Once the reflux is cured, the torticollis disappears.

3. Ocular torticollis: mostly congenital strabismus, the upper part of the eyeball is paralyzed to the torticollis, usually 9 months after birth, the sick child can sit still before diagnosis, because strabismus or diplopia attempts self-correction The symptoms of torticollis, after correcting eye muscle imbalance, strabismus disappeared.

4. Bone torticollis: Such as congenital short neck syndrome, in addition to abnormal neck posture, as well as limited neck activity, in addition, the posterior hairline is low, the skin on both sides of the neck also exist.

5. Infant benign paroxysmal torticollis: Infant occasional benign paroxysmal torticollis, each attack time from 10min to several days, and may have lateral scoliosis, good prognosis, after surgery for 1 to 5 years (Average 2 years) self-healing, the cause is unknown, sometimes ataxia after the onset of cessation, seems to be related to cerebellar dysfunction.

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