The incidence of
congenital torticollis in association with
plagiocephaly is 1 in 300 newborns, with the
torticollis resulting from pathologically sustained contraction of the sternocleidomastoid. Such conditions as
facial asymmetries, craniovertebral anomalies, cervical hemivertebra, and mono- or polydysostoses may also be associated with
torticollis diagnosed during the neonatal period. With particular reference to synostotic (coronal and/or lambdoidal)
plagiocephaly, a clear distinction is made in this paper between posterior neurocranial flattening secondary to the sustained rotation of the skull resulting from
torticollis and that seen in
synostotic plagiocephaly. The rarity of
torticollis with sustained contraction of the sternocleidomastoid muscle relative to the frequency of occipital-parietal flattening in newborn kept in the supine position has not been discussed in the literature and is therefore of clinical importance. In light of the fact that the prognosis and, consequently, the treatment plan vary directly with the presence or absence of
synostoses, clinical evaluation also includes cephalometrics, plain skull X-rays, and CT imaging. If the
torticollis is associated with neurocranial
deformity but
synostosis is absent, cervical
traction and physiotherapy resolve the symptoms. When, however, the clinical picture is complicated by
synostotic plagiocephaly, corrective surgery is necessary, though cervical
traction and physiotherapy are essential to provide early and complete cure of the
torticollis.