Concurrence of Congenital Muscular Torticollis and Congenital Torticollis Due to Other Anomalies: Two Case Reports

Abstract

Introduction: Congenital muscular torticollis (CMT) is the most common cause of torticollis in infants; other causes, including osseous, ocular, and central nervous system torticollis can easily be overlooked. We report two rare cases of CMT with concurrent osseous or ocular torticollis.Case 1: A 1-month-old female infant with a right neck mass and right-tilting head posture was referred. Neck ultrasonography showed diffuse hypertrophy and hyperechoic findings on the right sternocleidomastoid (SCM) muscle, which was consistent with right CMT. A clavicle X-ray imaging was conducted to identify an associated fracture due to birth trauma on the same day and a suspected congenital vertebral anomaly was coincidentally found. Subsequent three-dimensional computed tomography of the cervical spine showed a T1 hemivertebra causing the right-tilting head. The patient was diagnosed with the concurrent manifestation of CMT and congenital osseous torticollis.Case 2: A 3-month-old male infant with a 20° head tilt to the right with a limited cervical range of motion was referred. Neck ultrasonography showed a fibromatosis colli in the right SCM, suggesting CMT. He proceeded to physical therapy for seven months; however, there was little clinical improvement in his head and neck posture. The patient underwent an additional ophthalmologic examination and orbital magnetic resonance imaging (MRI) at 10 months of age. The result showed congenital agenesis of the left fourth cranial nerve with hypoplasia of the superior oblique muscle causing the right-tilting of the head. Ultimately, the boy was diagnosed with a concurrent manifestation of CMT and congenital ocular torticollis.Conclusion: Unless careful examinations are conducted, congenital vertebral anomalies and congenital agenesis of the fourth cranial nerve can go unnoticed in the present two cases. If a patient with CMT displays unusual features or does not respond to physical therapy, clinicians should consider not only a differential diagnosis but also concurrence with other causes of congenital torticollis.

Accessory Head of Sternocleidomastoid Muscle in Indian Cadavers: A Report of Three Cases

“…Congenital muscular torticollis caused by accessory heads of SCM leads to a restricted range of head and neck movement. It may also be associated with congenital osseous or ocular torticollis [ 6 ]. Multiple factors can contribute to torticollis, including damage to the SCM during delivery, tumors or pseudotumors involving the SCM, and abnormal postural damage [ 14 ].…”

“…Muscular torticollis is often associated with either ocular or osseous causes. [ 6 ]. Congenital SCM anomalies, SCM neoplasms, or peripartum SCM injury underlie the development of torticollis [ 7 ].…”

An unusual case of congenital torticollis

“…Although the predominant cause is muscular, there are various examples in the literature of the devastating consequences of misdiagnosing a progressive neurological lesion. [3][4][5] Although we understand it might be impractical to expect primary practitioners evaluating a child in a busy clinic to rule out the numerous neurological causes, we aim to highlight the importance of having a high degree of suspicion during these consults. [3][4][5] ANSWER 4…”

“…[3][4][5] Although we understand it might be impractical to expect primary practitioners evaluating a child in a busy clinic to rule out the numerous neurological causes, we aim to highlight the importance of having a high degree of suspicion during these consults. [3][4][5] ANSWER 4…”

Congenital Torticollis in a Child With Cervical Spine Deformity: A Case Report and Literature Review

“…However, degenerative arthritis close to the region of synostosis and present early in adulthood can make any anomaly at the lower cervical region that extends from C4 downward to become symptomatic [ 8 ]. It is also noted that some cervical anomalies are discovered incidentally [ 9 ].…”