congenital torticollis
Introduction
Introduction to congenital torticollis Congenital torticollis is a deformity in which the neck is tilted to one side after birth. The muscle-derived torticollis is called due to muscle lesions. The bone-derived torticollis is called due to skeletal malformation. . The real cause of congenital torticollis is still unclear. Clinical manifestations include neck mass, torticollis, facial asymmetry and other complications. The treatment is divided into non-surgical therapy and surgical therapy. basic knowledge Sickness ratio: 0.25% Susceptible people: young children Mode of infection: non-infectious Complications: cervical spondylosis spinal deformity
Cause
Congenital torticollis
The real cause of congenital torticollis is still unclear.
Clinical observations showed that 70% to 80% of cases were found on the left side, and 10% to 20% of cases were accompanied by congenital dislocation of the hip. In pathological anatomy, only the tissues forming the sternocleidomastoid contracture were confirmed. It is a fibrous tissue that has been denatured. Among them, the muscle fibers are completely destroyed and disappeared, the nucleus is mostly dissolved, and some residual nuclei are irregularly concentrated. Regenerated striated muscles and newborn capillaries may appear in the middle, and fibroblasts may also be found. There are several opinions about the emergence of this phenomenon.
Improper fetal position (20%):
Earlier than the Hippoerates era, pressure changes caused by malformation of multiple fetal fetuses in the uterus have been proposed. Recent studies have also shown that this type of compression of the sternocleidomastoid muscle due to changes in compressive stress is a torticollis deformity. One of the main reasons.
Birth injury (25%):
Congenital torticollis often occurs in cases of dystocia delivery, especially in breech presentations, accounting for about 3/4 of the cases, but opponents believe that in the histopathological examination, the fibrotic sternocleidomastoid muscle Any traces of hemosiderin were found to be visible, so it was speculated that it was not caused by a birth injury.
Blood flow blocked (15%):
Whether it is the arterial branch of the sternocleidomastoid or its venous branch, when it is occluded, it can cause muscle fibrosis, which can be confirmed by experimental research, which has not been widely accepted.
Genetic factors (20%):
Clinical investigations have found that about one-fifth of the children have a family history, and most of them have other parts of the deformity, indicating that it has a certain relationship with genetic factors.
Prevention
Congenital torticollis prevention
Pay attention to posture correction for children with torticollis should take correct posture correction. When breastfeeding, the child takes 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 sounds of the sounding and shining toys, as well as the TV, the tape recorder, etc., also come from the disease side; and the pillow can be used on the disease side. When the mother sits in a position to hold the child, let the sick side go up and train the muscles of the neck by looking up.
Complication
Congenital torticollis complications Complications cervical spondylosis deformity
Often caused by cervical vertebrae to the healthy side of compensatory scoliosis.
Symptom
Congenital torticollis symptoms common symptoms spastic torticollis progressive neck mass scoliosis fatigue visual impairment hip dislocation
Neck mass
This is the earliest symptom found by the mother or midwife. It is usually accessible after birth. It is located in the sternocleidomastoid muscle and is fusiform. It is 2~4cm long and 1~2cm wide. It has a hard texture and no tenderness. It was most obvious at the third week, and gradually disappeared after three months, generally not more than half a year.
Torticollis
After birth, the careful mother can find that the head of the child is obliquely on the side of the tumor (the affected side), which is more obvious after half a month. With the development of the child, the deformed torticollis is becoming more and more serious.
3. Facial asymmetry
Generally, after the age of 2, the facial features are asymmetrical, mainly as follows:
(1) Descent of the affected side: Due to the contraction of the sternocleidomastoid muscle, the position of the patient's eye is shifted from the original horizontal direction to the lower side, while the healthy side of the eye is raised.
(2) Mandibular steering to the healthy side: Due to the contraction of the sternocleidomastoid muscle, the affected side of the mastoid is moved forward and the entire mandible (capilla) is rotated to the opposite side.
(3) Deformation of both sides of the face: Due to the rotation of the head, the size of the double side holes is different, the healthy side is full and round, and the affected side is narrow and flat.
(4) Variation of the angle from the outer corner to the angle of the eye: measuring the distance from the outer corner of the eye to the angle of the same side, showing that the affected side becomes shorter and becomes more and more obvious with age.
In addition to the above performance, the entire face of the child, including the nose and ears, gradually showed asymmetry change, and was basically stereotyped in adulthood. At this time, if the surgery was corrected, the shape of the maxillofacial part was more ugly, so the treatment was performed. Strive to do it before the school age, not later than 12 years old.
4. Other
(1) with malformation: can check for hip dislocation, cervical vertebrae deformity and so on.
(2) Visual impairment: The eyes are not at the same level due to the torticollis, which is prone to visual fatigue and affects vision.
(3) Cervical scoliosis: mainly due to the rotation of the head and neck to the healthy side, thus causing compensatory scoliosis to the healthy side.
Examine
Congenital torticollis examination
1, ultrasound examination: especially for children with congenital muscular torticollis, ultrasound examination can be accurately identified with other diseases of the neck, such as cervical cystic lymphangioma, cervical lymphadenopathy. Especially when the tumor has disappeared at the time of the visit, ultrasound examination 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
Diagnosis and diagnosis of congenital torticollis
diagnosis
The diagnosis of this disease is more difficult, the key is to seek early detection of the newborn, to obtain early treatment to improve the efficacy and reduce the proportion of surgical treatment, therefore, the following points should be noted for the newborn when doing a whole body examination:
1. Is the bilateral neck symmetrical?
2. There is no mass in the bilateral sternocleidomastoid muscle.
3. Whether the baby's head and neck often tilt in the same direction.
The above three points are the early detection of this disease, the sooner the better.
Differential diagnosis
Cervical lymphadenitis
When the baby suffers from such a disease, the head and neck can also be tilted to the affected side, but at this time the mass is accompanied by obvious tenderness and is not in the same part as the sternocleidomastoid muscle, which is easy to distinguish.
2. Cervical vertebral deformity
Due to multiple congenital vertebral fusion malformations, it can be identified according to X-ray plain film and sternocleidomastoid muscle examination.
3. Other
Including various bone and joint injuries, such as cervical tuberculosis, spontaneous atlantoaxial dislocation, etc., should be noted for identification, rare polio sequelae may also include torticollis deformity, in addition, such as hysteria torticollis, habitual strabismus and Muscle spasm and torticollis after neck sprain are easily confused and should be excluded.
