Torticollis is a medical condition of abnormal head posture.  Patients can have either a head tilt, a head turn, or a combination of a head tilt and head turn.  Problems associated with chronic torticollis include neck problems, chronic acid reflux, and abnormal facial development (hemifacial microsomia).  Torticollis may be also occur as either a chin up posture or a chin down posture.

Torticollis may occur shortly after birth as the visual system is developing or may be developmental.  There are 2 main categorizations of torticollis, ocular torticollis and non-ocular torticollis.

Patients with non-ocular torticollis may have a head turn due to a problem with hearing or an abnormal head tilt due to an inner problem.  Patients with non-ocular torticollis may reflux or abnormal neck anatomy that requires treatment.  Your primary care physician may have you or your child evaluated by different specialists to determine the cause of the torticollis.

Ocular torticollis can occur when an eye muscle imbalance occurs.  The patient may have a vertical misalignment of the eyes and develop a head tilt or chin up posture.  If a horizontal misalignment of the eyes occurs, the patient may develop a head turn.  Nystagmus is an eye movement disorder and may also result in torticollis.

Treatment of torticollis varies depending on the condition.  In each case, treatment is specific to the type of torticollis, whether ocular or non-ocular.  In ocular cases, exercises are generally not particularly helpful in alleviating the muscle imbalance.  Many cases of ocular torticollis require some surgical intervention to realign the muscles that are imbalanced.  These surgical procedures are done on an outpatient basis.  Children with nystagmus can have improved range of vision and improved head alignment following surgery.  Patients with post-traumatic torticollis, usually involving the superior oblique muscle, can have reduction or resolution of their abnormal head posture.