Uncommon Cause of Torticollis in Children

Abstract

Torticollis originally derived from Latin words ‘tortus’ meaning twisted and ‘collum’ meaning neck. Torticollis is a pathological clinical sign that includes involuntary flexion of neck to the affected side and rotation to the opposite direction, resulting in the ear tilting toward shoulder and chin turning in the opposite direction. There is wide spectrum of underlying causes either congenital or acquired pathologies.

Congenital torticollis, most often of the muscular origin is caused by the fibrous scar formation in the sternocleidomastoid muscle due to the abnormal intrauterine fetus position, birth trauma or congenital cervical spine abnormalities. Otherwise, acquired is a clinical sign of numerous pathologies like syringomyelia, central nervous system disorder as well as laryngopharyngeal abnormalities that may lead to the contracted sternocleidomastoid muscle[1]. Thus, unmuscular torticollis necessitates multidisciplinary approach to establish proper diagnosis and the best intervention for the patient. A report showed 20- 40% retropharyngeal abscess in children presented with limitation of neck movement followed by other symptoms such as sore throat, fever, neck mass or respiratory distress[2]. Therefore, clinician should be aware retropharyngeal abscess (RPA) that may presented with the main symptom of torticollis. Early imaging studies may help to get diagnosis of RPA and to offer prompt surgical intervention to avoid fatal complication such as upper airway obstruction. Thus, torticollis should not be only treated symptomatically without exclusion of serious RPA because a delay of the proper diagnosis and implementation of adequate therapy may be fatal.