Congenital Muscular Torticollis vs. Second Cleft Sinus

Left picture: The diagnosis in this girl is a congenital muscular torticollis of the right side. Right picture: Here, the diagnosis is a branchial cleft sinus (second cleft sinus) of the right side. The observed torticollis is a momentary position of the head, possibly an expression of shyness.

A torticollis is visible in both girls at the instant the pictures were taken. Left picture: The 11.9-year-old schoolchild has a slight inclination to the right side in the picture at the top. The picture at the bottom shows distinctly the total right sternocleidomastoid muscle, the sternal and clavicular portion of which being prominent like a string on rotation of the head. Right picture: In this toddler the head is tilted to the left side. In the middle of the evenly visible sternocleidomastoid muscle of the right side a tiny opening is recognizable. A rotation of the head, or asymmetry of the face are not present. Left picture at the top: This photo of the face shows a torsion of the head to the left side, and an asymmetry of the face in disfavor of the right side.