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Torticollis

Alternative Names : Wry neck; Loxia

DEFINITION:
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.It is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.

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Symptoms:
•Limited range of motion of the head
•Headache
•Head tremor
•Neck pain
•Shoulder is higher on one side of the body
•Stiffness of neck muscles
•Swelling of the neck muscles (possibly present at birth)

Types of Torticollis:

Temporary Torticollis: This type of wry neck usually disappears after one or two days. It can be caused by:

*swollen lymph nodes
*an ear infection
*a cold
*an injury to the head and neck that causes swelling

Fixed Torticollis:  Fixed torticollis is also called acute torticollis or permanent torticollis. It is usually due to a problem with muscle or bone structure.

Muscular Torticollis:
This is the most common type of fixed torticollis. It is caused by scarring or tight muscles on one side of the neck

Klippel-Feil Syndrome:
This is a congenital form of wry neck. It occurs when the bones in an infant’s neck have formed incorrectly. Children born with this condition may have difficulty with hearing and vision.

Cervical Dystonia:
This rare disorder is sometimes referred to as spasmodic torticollis. It causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment. However, there is a risk of recurrence.

This type of wry neck  or Torticollis can happen to anyone. However, it is most commonly diagnosed in middle age. It affects more women than men.

CAUSES:
Torticollis  can be inherited. It can also develop in the womb. This may happen if the fetus’ head is in the wrong position. It can also be caused by damage to the muscles or blood supply to the neck.

Anyone can develop wry neck after a muscle or nervous system injury. However, most of the time, the cause of wry neck is not known. This is called idiopathic torticollis.

DIAGNOSIS:
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.

Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated “null position,” etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.

TREATMENT:
Common treatments  might involve a multi-phase process:

1.Low-impact exercise to increase strong form neck stability
2.Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3.Extended heat application.
4.Repetitive shiatsu massage.

†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the occipital condyles – thereby relieving compression of cranial nerve XI in children with Torticollis. This is an example of Osteopathic Manipulative Treatment.

Acquired torticollis:
Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults…..

*A self-limiting spontaneously occurring form of torticollis with one or more painful neck muscles is by far the most common (‘stiff neck’) and will pass spontaneously in 1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is involved. Sometimes draughts, colds or unusual postures are implicated; however in many cases no clear cause is found. These episodes are rarely seen by doctors other than a family physician.

*Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.

*Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.

*Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.

*Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.

*The use of certain drugs, such as antipsychotics, can cause torticollis.

*Antiemetics – Neuroleptic Class – Phenothiazines

There are many other rare causes of torticollis.

Spasmodic torticollis:
Torticollis with recurrent but transient contraction of the muscles of the neck and esp. of the sternocleidomastoid. “intermittent torticollis . “cervical dystonia”

TREATMENT: Botulinum toxin has been used to inhibit the spastic contractions of the affected muscles.

In animals:.CLICK & SEE
The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other different animals.

Possible ComplicationsComplications may include:

•Muscle swelling due to constant tension
•Neurological symptoms due to compressed nerve roots

Prognosis:
The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Torticollis
http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm
http://www.umm.edu/imagepages/19090.htm

http://commons.wikimedia.org/wiki/File:Sternocleidomastoideus.png

http://www.healthline.com/health/torticollis#Causes2

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Secrets Your Dentist Doesn’t Want You To Know

Here are the secrets your dentist may not want you to know — but you need to know to get the best care possible:

………………..
Secret #1: Your dentist may not be as educated as you think.

Dentistry has changed a lot since your dentist graduated from dental school. There have been major advances in most materials used in fillings, bonding and root canals. If your dentist is not actively engaged in continuing education, it is unlikely that he or she is keeping up with these developments.

Secret#2. Your dentist may not have the latest technology. ret #2:

Digital x-ray: Dentists who do not have digital x-ray equipment are practicing in the dark ages. Digital x-rays use less radiation than film. They are easier to read and the ability to manipulate contrast makes diagnosis more accurate.

Ultrasonic Cleaning: Ultrasonic instruments vibrate plaque and calculus off your teeth, even in areas below your gums. It is much more comfortable than old-fashioned hand scraping.

CEREC: The CEREC system lets your dentist provide a ceramic crown or veneer in only one visit. CEREC means fewer injections, less drilling and no annoying temporaries.

Diagnodent: This is a laser that the dentist shines on the tooth and it tells whether there is a cavity and how deep it is. With the use of this technology, the dentist can detect cavities, and find them at an earlier stage, than traditional poking around the tooth.

Secret #3: Your dentist may be using mercury.

Mercury is toxic. Norway and Sweden have banned the use of mercury fillings.. But mercury fillings are less expensive and easier for the dentist to use. If your dentist does not use composite fillings, don’t go to that dentist any more. In the US, the FDA is way behind the ball and not actively warning patients about this like they have been mandated by the courts to do.

Secret #4: The lab may be more important than your dentist.

Dental labs create dentures, crowns, bridges, orthodontic appliances, and other dental restorations like implant crowns. There is a huge difference in the quality of these labs. You should be particularly wary if your dentist is using a lab in China or Mexico. Some of the top labs in the U.S. are Aurum Ceramics, MicroDental Laboratories, da Vinci Dental Studio, and Williams Dental Lab.

Secret #5: There’s more to good dentistry than filling cavities.

A competent dentist screens for more than tooth decay. He or she should be concerned about sleep apnea, jaw-related pain known as TMJ or temporomandibular joint disorder, periodontal disease, oral cancer, diabetes and hypertension.

Secret #6: You are probably using the wrong specialist for dental implants.

Since dental implants involve the removal of a tooth and replacing it with an artificial tooth, many patients assume that an oral surgeon is best qualified to do it. This can be a flawed assumption. Periodontists, who specialize in gum disease, may be a better option. Periodontists have special training in gum tissue and underlying bone in the mouth, which are significant issues in dental implants.

Secret #7: Bad dental advice about dentures can be fatal!

Dentures are no joke. Your dentist should examine your dentures for evidence of wear. Wearing down the teeth on your dentures can result in distorted facial characteristics, collapse of the bite and closure of the airway.

Secret #8: Your dentist may not know enough about sleep apnea.

The most common form of sleep apnea is caused by a blockage of the airway during sleep. It is a pretty scary condition. The patient can stop breathing hundreds of times during the night. A common treatment for sleep apnea is Continuous Positive Airway Pressure (CPAP), which involves blowing pressurized room air through the airway at high enough pressure to keep the airway open.

As an alternative, your dentist, working with your physician, can custom make a device that guides the lower jaw forward, called a mandibular advancement device or MAD. MAD devices are more comfortable to wear and the compliance rates are much higher than using CPAP.

Secret #9: Not all cosmetic dentists have the skills to really improve your smile.

Any dentist can call herself a “cosmetic dentist.” Your dentist should be able to show you ten or more before and after photographs or videos, and be willing to give you the names of patients who have consented to be used as references.

Secret #10: How to avoid the root canal your dentist says you need.

Ask about the “ferrule effect.” Technically, this means that a root canal is unlikely to be successful if there is not enough tooth structure above the gum line to protect the tooth from coming loose or fracturing after it has been prepared for a crown. If your tooth fails the “ferrule effect” test, you might be better off with an extraction and an implant.

Source: Daily Finance August 27, 2009

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