congenital muscular torticollis
Introduction
Introduction to congenital muscular torticollis Congenital torticollis (congenitalwryneck), commonly known as neck, is a congenital malformation of the head and neck caused by the contraction of the sternocleidomastoid muscle to the affected side. Congenital muscular torticollis is caused by fibromatosis in the sternocleidomastoid muscle, which can cause swelling and mass during birth, or lumps and masses within the first two weeks after birth. basic knowledge The proportion of illness: 0.0025% Susceptible people: young children Mode of infection: non-infectious Complications: torticollis
Cause
Congenital muscular torticollis
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 and may be related to the following factors:
(A) Congenital sternocleidomastoid dysplasia, easy to be injured during childbirth.
(B) One side of the sternocleidomastoid muscle caused by hemorrhage caused by birth injury, formed a hematoma after the mechanization, and then contracted.
(C) Intrauterine fetal position is not correct, so that one side of the sternocleidomastoid muscle is subjected to excessive pressure, causing ischemia, and then excessive degradation, replaced by fibrous connective tissue.
(4) The pathological changes of the affected muscle tissue are similar to infectious myositis. Therefore, it is speculated that the sternocleidomastoid muscle causes aseptic inflammation due to birth injury, causing muscle degeneration and scarring, and forming a torticollis.
(5) Animal experiments have shown that the fibrotic changes of the sternocleidomastoid muscle can be caused by venous blockade. Therefore, some people think that this disease is related to the acute obstruction of the intramuscular vein of the sternocleidomastoid at birth. Most scholars now support the birth injury or intrauterine Poor position causes the ischemic theory.
Prevention
Congenital muscular torticollis prevention
The disease is a congenital disease, no effective preventive measures, early diagnosis and early treatment is the key to the prevention and treatment of this disease.
Pay attention to posture correction. Children with torticollis should take correct posture correction. When breastfeeding, the child should take the lateral position, adjust the position of the lying position while sleeping, so that the sun or the light shines on the sick side; the sounding and shining toys and the TV set, The sound of the recorder should also come from the disease side; and the pillow can be used on the side of the disease. When the mother sits horizontally, the child should be allowed to go up and the muscles of the neck can be trained by looking up.
Complication
Congenital muscular torticollis complications Complications
The complications of this disease are less reported, but with the development of this disease, the contraction of the sternocleidomastoid muscles is gradually aggravated, the secondary deformity of the head and face is aggravated, the side of the affected part is reduced, the two eyes are not in the same plane, and the lower jaw is turned to the affected side. Restricted, the sternocleidomastoid contracture is strip-like, the skull develops slightly and the shoulders are uneven.
Symptom
Congenital muscular torticollis symptoms Common symptoms Forced head and neck tilt deformity Head and neck activity restricted
Congenital muscular torticollis, a round or elliptical hard mass can be felt in the neck within the first 2 weeks after birth. The lumps can grow to the size of the jujube nucleus in 1 to 2 months, and then gradually change within 2 to 3 months. Small or disappeared, the right side is more common than the left side. Secondly, observe the child's head posture. The head of the child is often fixed in a correct position. The head is always biased to the side with the mass, and the face is facing the side without the mass. .
Examine
Congenital muscular torticollis examination
The more effective examination method commonly used in this disease is ultrasound diagnosis:
Congenital muscular torticollis, ultrasound imaging is the best diagnostic method, ultrasound can observe the continuity of the bilateral sternocleidomastoid muscle and the location, size, internal echo of the mass, and the sternocleidomastoid muscle and surrounding The relationship between the tissues and the ultrasound features of the disease is that the local sternocleidomastoid muscle has a spindle-shaped enlargement, which is consistent with normal muscle fibers. The sacral mass is non-enveloped, smooth, and the shape is mostly fusiform, but it can also be irregular. There may also be diffuse enlargement of the sternocleidomastoid muscle, which may be hypoechoic, mixed echo, and individual may also be augmented and reduced streaky echogenic changes, regardless of the echo, the lesion is in the sternocleidomastoid On the muscles.
Diagnosis
Diagnosis and diagnosis of congenital muscular torticollis
diagnosis
According to the hard mass of the neck within two weeks after birth, there is no redness and heat pain, the boundary is clear, and the activity can be diagnosed. X-ray films can be diagnosed without cervical abnormalities. The deformity can exist after birth, or after birth. 3 weeks, the head movement is slightly limited, but there is no obvious torticollis. The palpation can find a hard and painless fusiform mass, which is consistent with the direction of the sternocleidomastoid muscle, in 2 to 4 weeks. The inside gradually increases, then begins to retreat, gradually disappears within 2 to 6 months, some patients do not leave the torticollis; many patients without treatment, the muscles gradually fibrosis, contracture and hardening, forming a stiff neck-shaped strip The head is deformed by the contraction of the contracted muscles, and the face of the muscle shortening side is also deformed. If the deformity is not corrected in time, the facial deformation is aggravated, and finally the skull is asymmetrical, and the cervical spine and even the upper thoracic vertebrae are scoliosis. deformity.
Differential diagnosis
1, congenital cervical deformity neck is short and thick, activity is reduced, common cervical vertebrae, cervical fusion (Klippel Feil Syndrome).
2, cervical subluxation is mostly 3 to 5 years old children, pharyngeal inflammation caused by soft tissue around the cervical spine congestion, sudden head and neck deflection, limited mobility, muscle tension, cervical vertebrae open lateral radiograph visible neck 1 ~ 2 Half a bit.
3, children with ophthalmic diseases due to one side of myopia, the other side of hyperopia, the head and neck can be tilted to one side, but the sternocleidomastoid muscles are not contracted, the head and neck rotation is not limited.
4, other cervical disc disease, spinal space disease, one side of the sternocleidomast muscle deficiency can cause head and neck tilt.
In addition, it is necessary to identify lymph nodes, lymphomas, cervical dermoid cysts, carotid body tumors and other soft tissue tumors with enlarged neck. Two-dimensional ultrasound and CDF I can be identified.
