Congenital torticollis

Concerns about 3 % of births. It is a malposition, characterized by the inclination and rotation of the head to the trunk. As a general rule, the inclination affects the whole cervical spine while rotation is largely localized at the level of the first and second cervical vertebrae. Persistent torticollis may cause a malformation of the skull (plagiocephaly).

Congenital torticollis can be postural, muscular or osseous (table). Clinical examination enables to distinguish these three forms of torticollis, according to their reductibility: completely reducible and flexible (postural torticollis); tension at the level of the sternocleidomastoid muscle, following an intrauterine malposition or an obstetrical trauma to the muscle (" fibromatosis colli " or "olive" in the muscle), which renders the  reduction difficult (muscular torticollis); irreducible, rigid (osseous torticollis).

Postural torticollis is a transient cervico-cephalic malposition. Muscular torticollis is secondary to a unilateral retraction of the SCM and is the most common form of congenital torticollis. Retraction of the SCM induces a tilt of the head and cervical spine to  the side of the retracted muscle and a rotation of the skull to the opposite side. Bone torticollis is secondary to congenital osseous malformations, found for example in Klippel-Feil disease (see this term). This is a rare form often associated with plagiocephaly already present at birth.


Causes of torticollis in children

       osseous: cervical hemivertebrae, Klippel-Feil syndrome, occipital-cervical dysfunction

       non-osseous : congenital muscular torticollis, Sandifer syndrome (see this term)

       neurogenic: tumor of the CNS (intracranial hypertension), Arnold-Chiari syndrome, ocular torticollis


The evolution of the congenital torticollis depends on its cause. In most cases, the evolution is favorable, either spontaneously (postural torticollis), or after physiotherapy (muscular torticollis). Refractory cases of muscular torticollis and some forms of bone torticollis require a surgical management. In case of lately discovered congenital muscular torticollis for which physiotherapy management alone is not sufficient, an uni- or bipolar tenotomy or a Z plasty of the retracted sternocleidomastoid muscle can be proposed.


Anesthetic implications:

depending on the cause of torticollis, anesthesia of an infant.

ATTENTION: the apparition of a new onset persistent childhood torticollis is a mandatory reason of searching for a cervical spine problem (subluxation, for example in case of trisomy 21, or after ENT surgery or in case of Grisel syndrome, see this term) or for a neurological problem (brain tumor, dysfunction of a ventriculo-peritoneal drainage), or more rarely for a severe gastro-esophageal reflux.


References : 

-        François M. 
Que faire devant un torticolis ? 
Arch Pediatr 2013;20:22-3.

-         Freed SS, Coulter-O’Berry C. 
Identification and treatment of congenital muscular torticollis in infants.  
J Prosthetics & Orthotics 2004; 16, 4S, 18p.

-         Wicart P. 
Torticolis congenital. 
Arch Pédiatr 2012; 19: 335-9.


Updated: September 2019