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Houston Cranio Facial

What Causes Torticollis and Head Tilt?

Torticollis is defined as twisted or tight neck muscles causing a head to tilt to one side. Some parents ask what is the treatment for correcting a head tilt or neck tightness known as torticollis? To answer this question, we first need to understand the cause or reason for the head tilt. There are 3 main types of torticollis:

  1. Postural
  2. Muscular
  3. Neck or Sternocleidomastoid mass

When performing a physical exam to determine the cause we first looked at the eyes to make sure there is no strabismus or crossing of the eyes. Dr. Eric Payne, our extensively trained craniofacial plastic surgeon will then look to see if there is any skull flatness to suggest premature fusion of the bones. We will check the neck flexibility and range of motion. We will also look for the appearance of the muscle and to make sure there are no masses occurring within the muscle. We will check for facial appearance and asymmetry. We will also look for any spine deformity.

The typical treatment is to begin physical therapy to help stretch the muscle as well as strengthen the neck on the opposite side. We will also recommend beginning tummy time, which will also help strengthen the neck muscles. The goal is to begin these treatments very early to overcome the neck tightness. If treatment is delayed, then torticollis can be extremely difficult to treat without surgical intervention.

If physical therapy alone does not help treat torticollis, then other options can be pursued. We typically would obtain x-rays at this point to make sure there are no bony abnormalities causing the torticollis. Occasionally, abnormal development of the cervical vertebrae, such as with Klippel-Feil Syndrome, can cause head tilt because the head is not supported appropriately.

The next option, if physical therapy fails, is to use botulinum toxin or BOTOX® injected into the sternocleidomastoid muscle or the trapezius muscles to relax the tight muscles. The last option is surgery, which is performed to release the sternocleidomastoid muscle from the clavicle on one end and the insertion point into the back of the head just behind the ear for the other. Typically, this surgery is performed at about two years of age. The later this surgery is performed the worse the asymmetrical appearance of the face will become with time.

For more information, or to schedule a consultation and examination, please contact our practice.