Torticollis associated with positional plagiocephaly: a growing epidemic

J Craniofac Surg. 2005 May;16(3):411-8. doi: 10.1097/01.scs.0000171967.47358.47.


The primary study aim was to identify characteristics of torticollis associated with plagiocephaly without synostosis (PWS) and to differentiate this from other forms of torticollis. The three commonest causes of infantile torticollis are idiopathic muscular causes such as sternocleidomastoid fibrosis, structural anomalies in the cervical vertebrae, and neurologic or ocular causes, such as certain types of strabismus. Recently, several units have reported increasing numbers of babies presenting with head tilt and reduced range of cervical motion, a form of torticollis apparently associated with PWS and unrelated to the etiologies enumerated above. A secondary aim was to identify local trends in referral patterns over the preceding 3 years. This was a retrospective review of 159 children attending a secondary referral center for management of positional plagiocephaly or torticollis. The data was collected in a university-affiliated child development clinic, and the records of one of three similar, community-based outpatient clinics, staffed by physical therapists and working in conjunction with our tertiary craniofacial surgery center were analyzed by medical staff. There was a persistent escalation in referrals for both PWS and associated torticollis (ie, not attributable to 1 of the 3 causes mentioned) over the study period. Anatomic and clinical features of PWS-associated torticollis were characterised and contrasted with the classic forms of torticollis. Current treatment strategies are outlined and discussed. Torticollis can predispose to PWS, but in a large proportion of our cases of PWS, torticollis appears to develop secondary to plagiocephaly, and the number of presentations is escalating.

MeSH terms

  • Botulinum Toxins, Type A / therapeutic use
  • Female
  • Humans
  • Incidence
  • Infant
  • Male
  • Neck Muscles / physiopathology
  • Neuromuscular Agents / therapeutic use
  • New Zealand / epidemiology
  • Physical Therapy Modalities
  • Plagiocephaly, Nonsynostotic / complications*
  • Plagiocephaly, Nonsynostotic / epidemiology
  • Retrospective Studies
  • Supine Position
  • Torticollis / etiology*
  • Torticollis / therapy


  • Neuromuscular Agents
  • Botulinum Toxins, Type A