Cervical Spine Subluxation Associated with Congenital Muscular Torticollis and Craniofacial Asymmetry

Abstract

The relationship between craniofacial asymmetry, congenital muscular torticollis, and cervical spine subluxation was examined in a study of 30 children who presented to our Craniofacial Program from 1987 through 1990. Twenty-six of the 30 patients had craniofacial asymmetry and muscular torticollis without true suture synostosis documented by head and neck CT scans. These 26 patients had positional skull molding with consistent flattening of the contralateral occipitoparietal region and the ipsilateral fronto-orbital region relative to the side of the torticollis. Thirteen of the 26 patients also were found to have a C1-C2 subluxation. C1 was rotated forward of C2 on the side contralateral to the muscular torticollis in 12 of 13 patients. None of the patients with subluxation had neurologic deficits or required spinal stabilization. Ophthalmologic evaluations demonstrated amblyopia (4 patients) and horizontal strabismus (1 patient), both thought to be coincidental, with no evidence of nystagmus in any case. Seven of the 26 patients required surgical therapy for their neck muscle tightness, while the remainder responded to physiotherapy. Only 2 of the 26 patients underwent cranio-orbital reshaping for correction of their upper face asymmetry. Recognition of cervical subluxation in patients with congenital muscular torticollis may help to explain residual head-neck posturing problems even after successful neck muscle therapy.