The characteristic position of the head and neck ultimately results from a fibrous contracture. The muscle is strongly shortened and thickened by the connective tissue alteration and can be felt as such. This results in a tilted position in which the head and neck are tilted forward and to the side of the shortened muscle.
However, the face is inclined to the other side. The sick side may also have high shoulders. In very pronounced cases, the short, thick muscle can be seen from the outside.
It is visible as a thick strand under the skin. The symptoms may be partially pronounced in the newborn, but usually do not appear until a few weeks old. The symptoms of the neck are often accompanied by other skeletal misalignments.
These other misalignments include the secondary malformations that can result from an untreated torticollis. It can happen that the cervical spine adapts to the oblique position of the neck. The result is scoliosis (a malposition of the spine).
As a result of the scoliosis, deeper muscles in the cervical area may also shorten. Since babies tend to sleep on their stomachs and turn their faces to the sick side, facial scoliosis may also manifest itself in some cases. The baby’s skull is still soft and malleable in the first months of life.
The fact that uneven pressure is applied to the skull, since the baby is always lying on the sick side, causes the skull and face to deform. On the sick side the cheek is flattened, the eye is crooked. The corner of the mouth and the ear hang in a low position. The result is a clearly visible asymmetry of the face, which is not only a cosmetic problem for the children.
There are different therapeutic approaches. However, it is generally agreed that surgery is unavoidable in advanced disease with very pronounced scoliosis of the cervical spine. However, in the best case, this should not happen.
When symptoms appear for the first time, an attempt is made to counteract the malposition with stretching exercises and positioning. The baby is encouraged to turn his head in the other direction. The muscle is actively stretched through physiotherapy exercises several times a week.
However, if the torticollis has not been corrected after one year, an operation is necessary. The muscle is cut at both ends and fixed with a splint for about 6 to 8 weeks. If facial asymmetry has already developed by this time, it cannot be corrected. However, with early treatment there is a good chance that the neck’s misalignment can be completely corrected. The younger the patient is and the earlier physiotherapy and repositioning is started, the better the results.