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CONGENITAL MUSCULAR TORTICOLLIS AND CERVICAL DYSTONIA

Congenital muscular torticollis persisting to adult life is rare.1 Patients have a head tilt and a cord like sternocleidomastoid. It must be distinguished from adult onset cervical dystonia. Botulinum toxin can be used,3 4 but surgery is preferable.5 We report two patients with congenital muscular torticollis referred to a botulinum clinic. One a 17–year–old girl with suspected dystonia but worsening neck discomfort and a head tilt since infancy. Botulinum injections in the sternocleidomastoid were of partial benefit; surgery gave an excellent result. The other a 58–year–old man with torticollis since infancy with increasing left head rotation over 10 years, worsened by stress and walking. He had partial resection of the left sternocleidomastoid at age ten years. The cord was prominent on head movement without visible muscle contraction and he had a head tilt to the right. Walking increased chin rotation to the left and caused shoulder elevation. We interpreted increased head rotation to the left and new lateral head tilt to the right as adult onset cervical dystonia on a background of congenital muscular torticollis. Appropriate botulinum injections gave partial benefit and he continues on this. Videos of both patients are presented before and after treatment.