64.11 Torticollis in older children

A child’s head may turn to one side, or slip forwards onto his chest, due to the softening of his transverse ligament, which normally holds his atlas to his odontoid (this ligament is shown in B, Fig. 64-14). Torticollis can follow a variety of neck or throat infections, such as peritonsillar abscesses, or it can follow an injury. Measure the distance between the child’s odontoid peg and the back of the anterior arch of his axis. If this is more than 3 mm in adults or 4.5 mm in children, his transverse ligament has been stretched and the ring of his atlas has slipped forward. Atlanto–axial subluxation is serious, because paraplegia may follow, and because of the torticollis which may last weeks, or occasionally permanently, if you don’t treat it. The differential diagnosis includes tuberculosis, but here collapse is much more usual than subluxation.

ATLANTO-AXIAL SUBLUXATION Exclude tuberculosis. if necessary, treat the child’s respiratory infection.

Treat him in gentle halter traction for 2 weeks, and then apply a soft collar, with his head turned slightly in the corrected position. Maintain this position by wrapping a few turns of plaster round the collar. Many patients will recover with this treatment, but not all of them.