Other Cervical Spine Disorders

Chin is twisted upwards & towards one side

may be Congenital or Acquired

Congenital

1. Congenital Muscular Torticollis (see below)
2. Klippel -Feil syndrome

Acquired

may be Osseous or Non-osseous

1. Osseus, 
   1. Trauma - Atlantoaxial 
   2. Infections
      1. tuberculosis
      2. pyogenic infections
      3. Grisel's syndrome - follows upper respiratory tract infection
   3. Tumours
      1. Osteoid osteoma
   4. Inflammatory
      1. ankylosing spondylitis
      2. Rheumatoid arthritis
   5. Non-osseus
      1. neck burn contractures
      2. ocular - with a superior oblique muscle paresis creating a compensatory head tilt
      3. Prolapsed disc
      4. Tumours 
         1. intraspinal
         2. intracranial - posterior fossa (medulloblastomas, cerebellar astrocytomas, ependymomas)

• the sternomastoid on one side is fibrous & fails to elongate with growth -> progressive deformity
• associated with breech & DDH
• may be due to ischaemia of the muscle from a distorted position in-utero
• Clinical
  • lump may be noticed in first few weeks of life
  • deformity appears at age 1-2 years
  • sternomastoid feels tight & hard
  • asymmetrical facial development
• Treatment
  • division of muscle - usually at lower end, but may require division at upper end as well; immobilise with a collar, then stretching exercises