Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry

Abstract

Background:Assessment of facial asymmetry is challenging in torticollis deformity. Neck tilt in toroticollis is associated with deviation of horizontal ocular gaze and translation of neck from the midline. These deviations can be assessed clinically and can be used as surrogate marker for facial asymmetry.Materials and Methods:Thirty five children with congenital muscular torticollis (CMT) were classified into three grades of severity based on the new clinical score. The parameters included in the scoring system included rotational deficit, side flexion deficit, gaze angle (GA), and translational deformity (TD). Seven children had Grade I (mild), 18 had Grade II (moderate), and 10 had Grade III (severe) CMT. There were 21 girls and 14 boys with a mean age of 8.46 years (range 3–16 years). Twenty two children underwent a bipolar release, and 13 had unipolar surgery. Facial asymmetry (FA) signs were noted and based on GA and TD; all children had a deviation from the neutral angles (GA of 90° and 0 mm translation from the midsterna plumb line were considered neutral angle). The final outcome was based on the modified Cheng and Tang Score.Results:The mean GA in Grade I, II, and III improved from 81.71 to 90, 72.77 to 89.16, and 66.60 to 88, respectively (Chi-square P < 0.0001). The TD improved from 15 mm to 0 mm, 25.83 mm to 3.05 mm, and 36.6 mm to 6 mm in Grade I, II, and III, respectively (Chi-square P < 0.05). The rotational and side flexion deficits also improved across all grades of severity but were not statistically significant (P < 0.911 and P < 0.04). Twenty four children had an excellent outcome with complete correction of their GA and TD. Four children with Grade II CMT and seven children with Grade III who had a residual translation of 5 mm or more and GA less than neutral horizontal had a good outcome. No child had problems with scar cosmesis or prominent lateral bands, and there was no recurrence of deformity at a mean followup of 28 months (range 24–32 months).Conclusion:The GA and TD can be used to assess FA in torticollis management and significant improvement can be expected even in severe cases.

Surgical treatment of torticollis secondary to the presence of a congenital paracondylar process: illustrative case

“…Four months after surgical intervention, no notable torticollis was found on clinical examination, and her cervical flexion was 50°, extension 54°, left rotation 72°, right rotation 84°, left lateral flexion 24°, and right lateral flexion 35°. Using methods described by Bhaskar et al 8 the patient’s preoperative translational deformity was measured to be 8.1 mm and her gaze angle was 72° ( Fig. 5A and B) Postoperatively, her translational deformity was completely corrected (0 mm) and her gaze angle was 88° ( Fig.…”

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

“…1 Some degrees of facial asymmetry may be normal in the healthy population. [2][3][4] However, one possible cause of facial asymmetry is torticollis, which may be secondary to orthopedic, neurologic, and ocular abnormalities. 1,[4][5][6] Ocular torticollis is caused by problems such as congenital superior oblique muscle palsy (SOP), Duane retraction syndrome, dissociated vertical deviation, sixth-nerve palsy, nystagmus, and other eye muscle palsies.…”

“…[2][3][4] However, one possible cause of facial asymmetry is torticollis, which may be secondary to orthopedic, neurologic, and ocular abnormalities. 1,[4][5][6] Ocular torticollis is caused by problems such as congenital superior oblique muscle palsy (SOP), Duane retraction syndrome, dissociated vertical deviation, sixth-nerve palsy, nystagmus, and other eye muscle palsies. 2,[7][8][9] Congenital superior oblique palsy is a form of vertical strabismus, 10 which mimics true paresis or palsy of the fourth cranial nerve.…”

“…Facial asymmetry is a condition in which the face is not symmetrically balanced on both sides 1 . Some degrees of facial asymmetry may be normal in the healthy population 2–4 . However, one possible cause of facial asymmetry is torticollis, which may be secondary to orthopedic, neurologic, and ocular abnormalities 1,4–6 .…”