What department should I go to for torticollis in children?

When children with torticollis go to the hospital, they should go to the pediatric orthopedics department. Torticollis is a very common pediatric orthopedic disease, which may be caused by malposition of the fetus, injury during delivery, etc. Once the child finds symptoms of torticollis, it must be treated in time. It can be treated with massage within one year old, but massage will not be so effective after one year old. It can be treated with surgical correction.

Causes

The cause is unknown, but may be related to the following factors

(1) The sternocleidomastoid muscle on one side was injured during childbirth. Bleeding occurred due to birth trauma, forming a hematoma which then became ossified and subsequently contracted.

(2) Malposition of the fetus in the uterus causes excessive pressure on one side of the sternocleidomastoid muscle, resulting in local ischemia and subsequent excessive degeneration, which is replaced by fibrous connective tissue.

(3) Aseptic inflammation caused by birth trauma leads to muscle degeneration and scarring, resulting in torticollis.

(4) It is related to acute obstruction of the sternocleidomastoid vein at birth.

Note:

(1) It should be differentiated from skeletal torticollis, postural torticollis, ocular torticollis, etc.

(2) Discover and treat promptly. It is generally best to start treatment within 3 months of birth. When the lump disappears, massage should be continued until the neck movement becomes normal.

(3) If ineffective after 1 year of age, surgical correction may be considered.

(4) Children with torticollis should also be examined for other congenital malformations, especially congenital hip dislocation (they can go to the hospital to take bilateral hip joint X-rays for diagnosis).

(5) Children should not be held upright too early to prevent postural torticollis.

Surgery

1. Indications for surgery:

(1) Persistent sternocleidomastoid muscle contracture with limited head rotation for more than 12-15 months;

(2) Persistent sternocleidomastoid muscle contracture with progressive unilateral facial hypoplasia;

(3) Muscular torticollis detected in children over 1 year old. Or if there is no improvement after one year of conservative treatment, surgical treatment should be considered.

2. Surgical method:

(1) Sternocleidomastoid muscle release: For children under 5 years old, the clavicular head and sternal head can be simply cut and released, while for children over 6 years old, mastoid head release is required.

(2) Z-shaped lengthening of the sternocleidomastoid muscle In order to make the patient's neck look more beautiful after surgery, some scholars use the "Z"-shaped lengthening of the sternocleidomastoid muscle.

Note: Avoid damaging the subclavian artery, vein, common jugular vein and accessory nerve during the operation.

Postoperative treatment

For patients under 2 years old, a cervical collar can be used for fixation after surgery. For older patients, a cervical plaster cast can be used to fix the patient, with the head tilted toward the healthy side and the mandible turned toward the affected side. After 4 to 6 weeks of fixation, rehabilitation exercises and physical therapy should be performed to prevent further contracture and maintain the best condition.

In short, early detection and early treatment are important. If conservative treatment fails, surgical treatment should be chosen as early as possible. The surgical age is usually around 1 year old, and it is best not to exceed 1 and a half years old.