Congenital muscular torticollis concurrent with sagittal synostosis: a case report

Abstract

Congenital muscular torticollis (CMT) and craniosynostosis are diseases that cause plagiocephaly and craniofacial asymmetry in children. In our literature review, we did not find any report of concurrent manifestation of CMT and craniosynostosis. A 41-month-old boy visited our hospital with left torticollis, right laterocollis, and craniofacial asymmetry as the main findings. During clinical examination, prominent right sternocleidomastoid muscle and limited range of motion of the neck were noted, and right CMT was confirmed by magnetic resonance imaging of the neck. Three-dimensional computed tomography of the skull, which was conducted due to the unusual appearance of the skull with a large head circumference, mild brachycephaly, as well as left plagiocephaly, revealed premature closure of the sagittal suture. Thus, we report the first case that showed concurrence of CMT and sagittal synostosis. We recommend that concurrently manifested craniosynostosis needs to be examined if the subject with CMT displays unusual craniofacial asymmetry to a greater extent than deformational plagiocephaly.

Keywords: Craniosynostosis; Plagiocephaly; Torticollis.

Fig. 1

A 41-month-old boy shows (A) sternal (solid arrow) and clavicular (dotted arrow) heads of the right sternocleidomastoid muscle, which are more prominent than those on the left side (short arrows). (B) Measurement of the range of motion for cervical rotation shows a 30° deficit in the cervical rotation to the right side and (C) a 30° deficit in lateral flexion to the left side compared with that on the contralateral side.

Fig. 2

(A) T1-weighted coronal and axial magnetic resonance images of the neck display fusiform thickening and low signal intensity within the right sternocleidomastoid muscle (solid arrow). (B) Three-dimensional computed tomography of the brain shows premature closure of the sagittal suture (black arrows) with left occipital plagiocephaly (dotted arrow) and flattened right zygomatic arch (white arrow).