CERVICAL-SPINE SUBLUXATION ASSOCIATED WITH CONGENITAL MUSCULAR TORTICOLLIS AND CRANIOFACIAL ASYMMETRY

The relationship between craniofacial asymmetry, congenital muscular t orticollis, and cervical spine subluxation was examined in a study of 30 children who presented to our Craniofacial Program from 1987 throug h 1990. Twenty-six of the 30 patients had craniofacial asymmetry and m uscular 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 an d the ipsilateral fronto-orbital region relative to the side of the to rticollis. Thirteen of the 26 patients also were found to have a C1-C2 subluxation. C1 was rotated forward of C2 on the side contralateral t o the muscular torticollis in 12 of 13 patients. None of the patients with subluxation had neurologic deficits or required spinal stabilizat ion. Ophthalmologic evaluations demonstrated amblyopia (4 patients) an d horizontal strabismus (1 patient), both thought to be coincidental, with no evidence of nystagmus in any case. Seven of the 26 patients re quired surgical therapy for their neck muscle tightness, while the rem ainder responded to physiotherapy. Only 2 of the 26 patients underwent cranioorbital reshaping for correction of their upper face asymmetry. Recognition of cervical subluxation in patients with congenital muscu lar torticollis may help to explain residual head-neck posturing probl ems even after successful neck muscle therapy.