Postural Torticollis (Differential Diagnosis Congenital Muscular Torticollis)

scha_12a_n.jpg and scha_12b_n.jpg: The left-sided posterior plagiocephaly reminds of a left-sided uni- or bilateral lambdoid synostosis (which is more distinct on the left side), or - which is encountered much more frequently - a positional plagiocephaly not caused by torticollis. In lambdoid synostosis additional signs are present which are missing in this case. $$kran_10??££See figures for comparison§§. In case of an isolated positional plagiocephaly a torticollis is missing, or if it is present as in this case with postural plagiocephaly, the sternocleidomastoid muscle is hypertonic, not fibrotic, and in 2/3 of the cases there is no constricted rotation of the head, and only of a slight degree in 1/3 (15 degrees or less). A differentiation between postural plagiocephaly due to hypertonus of the sternocleidomastoid muscle and plagiocephaly combined with congenital muscular torticollis may be difficult in such cases, and only follow-ups enable a correct diagnosis; a postural plagiocephaly due to hypertonus usually has a good prognosis and does not need surgery.