Torticollis of Babies

By: Joe Hing Kwok Chu         按此看中文

Causes of torticollis of babies:

1. Congenital abnormality of cervical vertibrae

2. Congenital muscular torticollis due to contracture of the  sternocleidomastoid muscle

The causes of congenital muscular torticollis are not completely clear. The probable causes can include abnormal compression of fetus in the womb during development or difficulty during labor which causes injury to the sternocleidomastoid muscle of the baby and causes bleeding of the muscle. The hematoma then in turn causes lack of circulation of blood,  fibrosis (hardening of the tissues), and shrinkage of the muscle.

Babies of 1 to 2 weeks old with congenital torticollis often show a bulging piece of muscle on one side of the neck. The muscle is slightly hard and not sensitive to pressure. The head tilts to the injured side and the chin points at the healthy side. After 2 to 4 months the swollen mass will gradually begin to subside due to the re-absorption of the hematoma. If you force the head into a central position rather than a tilted position, you can feel the affected sternocleidomastoid muscle because it is tight like a rubber band.

Prognosis

If not treated, the tilting can gradually become more serious. The face of the affected baby will gradually appear to be asymmetrical because lack of circulation affects normal development of the muscle. The blockage also affects the blood circulation of the brain.  The head will become flatter on one side because of the injured baby favors lying on one side. At about one and half year old the development of the affected side of the face is slower; thus it becomes smaller. The cervical vertibrae can actually begin to protrude secondarily (because of the injured neck muscle) to the healthy side. Usually after two to four months, the hematoma will oftentimes be re-absorbed but the head will continue to tilt to the injured side and the chin will point to the healthy side without treatment.  Usually the torticollis will not be outgrown, without treatment.

The treatments:

Treatments are based on the baby's age.  (More will be uploaded)

After the second week after birth, it is important to carefully turn the baby's head, 3 to 4 times a day. Using small sand bags or bean bags can help to steady the baby's head during sleep.  Using a warm herb decoction massage is very useful in helping to re-absorb the hematoma; this treatment is effective for mild injuries. If the baby is over six months old, and if these methods are ineffective, after excluding other possible causes (such as bone injuries), usually surgery is being performed on the sternocleidomastoid (neck muscle).  Often if treated earlier, surgery is usually not necessary.

斜頸

頸部有一對重要的肌肉 叫胸鎖乳突肌，左右各一塊，一些嬰兒出生後常常發現頭部偏向一側，俗稱“歪脖”，這是怎麼回事呢?除了頸椎骨的先天性畸形外，常見的原因就是頸部一側的胸 鎖乳頭肌發生攣縮，使頭部向患側偏斜所致，故稱為先天性肌性斜頸。
引起先天性肌性斜頸的原因目前尚未完全了解。可能的原因包括：①胎兒頭部在子宮內發育過程中受異常壓迫，造成胸鎖乳頭肌攣縮；②難產時，造成胎兒產傷，使 胸鎖乳頭肌出血、血腫，繼而缺血、纖維化，導致攣縮等等。
先天性肌性斜頸的患兒在生後1～2周常可發現頸部一側胸鎖乳頭肌內有一梭形包塊，無壓痛，質地較硬。2～4個月後腫塊可逐漸消失(因血腫逐漸吸收)，頭偏 向患側，下頜轉向健側。如不治療則頭偏斜逐漸加重。1歲半左右，患兒面部逐漸出現不對稱，患側面部發育較小。頸椎骨可繼發凸向健側。如將頭部勉強擺正時， 患側胸鎖乳頭肌在皮膚下組緊，像一條索帶。
先天性肌性斜頸的治療因年齡不同而異。對半歲以內的患兒，可採用局部熱敷、按摩等保守方法治療，目的是促進胸鎖乳頭肌內血腫早吸收，防止肌肉纖維化和攣縮 。睡覺時頭偏向健側，並用小砂袋固定頭部，保持這種位置。生後2周可開始採用手法牽引治療，即將頭枕部緩慢輕柔地旋向健側肩部，每日3～4次。這些方法對 輕度肌性斜頸患兒有效。
如果採用上述方法治療無效或年齡超過半歲的患兒，在排除其它病變後，可採用手術矯正。手術方法包括胸鎖乳頭購買切斷術或切除術。年齡較小的患兒在術後臉部 畸形容易恢復到正常。一般大於12歲的兒童，合並臉部嚴重畸形不對稱者，應慎重手術，因為此時矯正斜頸後，臉部畸形不再改善，仍然是患側臉小，反而使畸形 更加明顯。外觀效果不好。如果臉部畸形不嚴重者，則仍可以手術治療。

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