torticollis
Introduction
Introduction to the torticollis The torticollis can be divided into congenital muscular torticollis and congenital pelvic torticollis. The former is a congenital neck deformity caused by head and neck slanting caused by one side of the sternocleidomastoid contracture. It is quite common; the latter is due to cervical vertebrae. The torticollis caused by abnormal bone development is less common. One out of five children have a clear family history, so they are thought to be genetically related, and such children often have other parts of the congenital acetabular dysplasia. basic knowledge The proportion of illness: 0.0025% Susceptible people: young children Mode of infection: non-infectious Complications: cervical spondylosis
Cause
Cause of torticollis
Abnormal internal pressure (30%):
If the fetus is not properly positioned in the uterus or is subjected to abnormal uterine wall pressure, the neck of one side may be compressed, and the local blood supply in the sternocleidomastoid muscle may cause the ischemic fibrosis of the muscle to cause the torticollis. It is considered to be a vascular plug of the sternocleidomastoid muscle, which leads to the degeneration of the muscle fiber and the formation of the torticollis.
Dystocia (30%):
The use of forceps is one of the causes of muscular torticollis, because this disease occurs mostly in the breech producer, but the examination of the local mass of the sternocleidomastoid does not reveal traces of old bleeding, so this view has not been finalized. Confirmed. One out of five patients with this disease have a clear family history, so it is thought to be related to heredity, and such children often have other parts of the congenital acetabular dysplasia.
Thoracic sacral mastoid mass (30%):
Mainly for the cord-like fibrotic muscle tissue, the general specimen looks like a soft fibrous scar, the cut surface is white, and it is observed by the dense fibrous tissue under the microscope. The muscle tissue is reduced, the transverse stripes are reduced, and the severe muscle tissue disappears. More scar tissue appeared, but there was no bleeding in the muscle.
According to the proportion of muscle and fibrous tissue, it can be divided into three pathological types:
1. Muscle type: Muscle tissue or fibrous tissue mainly composed of muscle tissue and containing only a small amount of fibrosis.
2. Mixed type: contains muscle tissue and fibrous tissue.
3. Fibrous type: It is mainly composed of fibrous tissue and contains a small amount of muscle or degenerated muscle tissue.
This classification has certain guiding significance for the determination of clinical curative effect. Under normal circumstances, the muscle type has better curative effect and the fiber type has poor curative effect.
Prevention
Torticol prevention
Most of the disease is congenital, there is no effective preventive measures, the most important clinical is to do early detection, early diagnosis, early treatment, to prevent further damage to the child. Give liquid or semi-liquid foods, such as various porridge, rice soup and so on.
Complication
Oblique neck complications Complications cervical spondylosis
Congenital muscular torticollis has not been effectively treated in the early stage. Facial and facial deformities will appear after 2 years of age, mainly manifested as facial asymmetry. The distance between the bilateral ocular extraocular corners to the mouth is asymmetric, the distance on the affected side is shortened, and the healthy side is growing. The lateral position of the lateral eye is lowered. Because the eyes are not on the same horizontal line, visual fatigue is likely to occur and the vision is reduced. The healthy side is round and full, the affected side is narrow and flat, and the cervical vertebra can undergo compensatory scoliosis. In addition, asymmetry changes can occur in the entire face of the child, including the nose and ears.
Symptom
Symmetrical symptoms of torticollis Common symptoms Coerced head and neck tilt deformity Facial deformity Progressive neck mass
The clinical manifestations of the torticollis are mainly the following:
1, torticollis deformity
After the baby is born, the mother can find that the head of the child is tilted to the affected side, the face is rotated to the healthy side, and the lower jaw points to the shoulder of the healthy side. After 2 to 3 weeks, the deformed torticollis is more obvious, and the head is turned to the healthy side. The lighter ones should be carefully observed to find out that this symptom is increasing with the growth of the child.
2, neck mass
Generally, the neck mass can be touched after birth or within 2 weeks after birth. It is located in the lower part of the sternocleidomastoid muscle. It is more common in the right side. The mass is fusiform and has no tenderness, usually in 1 to 2 months. After reaching the maximum, then gradually shrink to complete disappearance, some of these children can occur that the mass does not disappear and muscle fibrosis and contracture cause torticollis deformity.
3, facial deformity
Congenital muscular torticollis has not been effectively treated in the early stage. Facial and facial deformities will appear after 2 years of age, mainly manifested as facial asymmetry. The distance between the bilateral ocular extraocular corners to the mouth is asymmetric, the distance on the affected side is shortened, and the healthy side is growing. The plane position of the side eyes is lowered. Because the eyes are not on the same horizontal line, visual fatigue is easy to occur and the vision is reduced. The healthy side is round and full, the affected side is narrow and flat, and the cervical vertebra can have compensatory scoliosis. In addition, the patient suffers from Asymmetry changes can also occur throughout the face, including the nose and ears.
In addition to the above main performance, this disease can be combined with congenital acetabular dislocation and other cervical deformities.
Examine
Torticollis examination
The examination methods of this disease mainly include the following:
1, ultrasound examination: especially for children with congenital muscular torticollis, ultrasound examination can accurately identify other diseases of the neck, such as cystic lymphangioma of the neck, cervical lymphadenopathy, etc., especially when the tumor has disappeared Ultrasound is more important.
2, X-ray examination, is conducive to the identification of different causes of the torticollis, such as the occipital torticollis caused by occipital neck deformity and the spontaneous cervical atlas rotatory subluxation caused by the torticollis generally does not produce sternocleidomastoid muscle The contracture and mass, the latter has a history of minor trauma or upper respiratory tract infection.
For cases where the above examination methods are difficult to diagnose, CT examination can be performed, which can provide a clearer image, which is conducive to diagnosis and elimination of organic lesions.
Diagnosis
Diagnostic diagnosis of torticollis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
(1) Congenital skeletal torticollis: This disease is caused by congenital occipital neck deformity, including short neck deformity, skull base depression, hemivertebra deformity, occipital condyle fusion and odontoid developmental malformation. It can cause asymmetry of the torticollis and the face, but generally does not produce a typical strip-like contracture band and mass of the sternocleidomastoid muscle. X-ray examination can confirm the above diagnosis.
(2) Pediatric neck lymphadenitis: Infancy with cervical lymphadenitis, can quickly occur in the neck and neck swelling, but this mass is often tender and not located in the chest papillary muscle.
(3) Spontaneous atlantoaxial rotatory subluxation: Atlantoaxial rotatory subluxation can also cause torticollis, but this disease has a history of minor trauma or upper respiratory tract infection, mainly characterized by limited neck rotation and neck The symptoms of pain are obvious, and there is no tension band in the sternocleidomastoid muscle. X-ray examination can be identified.
(4) Cervical tuberculosis Cervical tuberculosis can cause sternocleidomastoid tendon and produce torticollis, but such patients have obvious neck pain, neck activity is obviously limited, and the mandible is biased to the affected side. X-ray examination can confirm the diagnosis.
In addition, it is also necessary to distinguish from the torticollis caused by hysteria torticollis, habitual torticollis, injurious torticollis, and sequelae of poliomyelitis.
