Torticollis is defined as a condition where the head is tilted toward one side and the chin is pointing in the opposite direction. 

Etiology

1. Congenital muscular torticollis
1. approximately 1% incidence
2. Often associated with a difficult delivery or breech presentation
3. Often not noted until 2-8 weeks of age
4. May feel a firm mass within the SCM muscle which is fibrous tissue that causes shortening of the muscle and resulting tilt
5. Most of the time it resolves spontaneously, and may treat with passive stretching and heat. If associated with facial and cranial asymmetry after one year of age, surgical intervention may be necessary.
2. Congenital positional torticollis 
1. Usually present at birth and thought to be secondary to intrauterine positioning. Resolves spontaneously.
3. Trauma- usually painful and limitation of motion
1. muscle injury
2. Fracture of vertebrae or clavicle
3. of atlantoaxial joint
4. Posterior fossa tumors
5. Hysteria
6. Cervical adenitis, retropharyngeal abscess,  or any cervical mass
7. Ocular abnormalities like strabismus, muscle weakness, and nystagmus
8. Gastroesophageal reflux
9. Drugs- phenothiazines may be associated with posturing
10. Grisel's Syndrome- an antecedent inflammatory process in the head area may lead to subluxation of the atlantoaxial joint and torticollis. Has been associated with T &A, pharyngitis, parotitis, and mastoiditis. May need traction or neck brace 

1. History- trauma, pain, birth history, recent infections, drugs, any neurological symptoms like vomiting, ataxia, eye changes, difficulty breathing, stridor, drooling, recent URI or otitis media.
2. Physical examination- should include careful examination of the head and neck and careful neurological examination. 
3. Most cases can be diagnosed after physical examination and history. If there are pertinent neurological findings and the child does not improve with symptomatic treatment such as analgesics, heat, and rest, consultation with ENT, Orthopedics, or Neurology may be necessary. CT and MRI may also be indicated.

1. Tom, L, Rossiter,J, et.al Torticollis in Children. Otolaryngology-Head and Neck Surgery. July 1991