Torticollis, facial asymmetry and plagiocephaly in normal newborns
Lisa Stellwagen 1*, Eustratia Hubbard 1, Christina Chambers 2 and Kenneth Lyons Jones 2
1 UCSD Medical Center, United States
2 UCSD School of Medicine, United States
* To whom correspondence should be addressed. E-mail: lstellwagen{at}ucsd.edu.
Accepted 25 March 2008
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Objective: To evaluate the incidence and characteristics of torticollis, plagiocephaly, and facial asymmetry in normal newborn infants.
Design: One hundred and two healthy newborn infants were examined prospectively during their birth hospitalization for torticollis with neck range of motion (ROM) assessment, and for facial, mandibular, and cranial asymmetry by photographic analysis.
Results: Seventy-three percent of newborns had one or more asymmetry: torticollis (16%), asymmetry of the mandible (13%), facial asymmetry (42%), and asymmetry of the head (61%). Torticollis was associated with maternal report of having been "stuck" in one intrauterine position for more than 6 weeks prior to delivery. Moderate facial asymmetry was associated with a longer second stage of labor, forceps delivery, a bigger baby, and birth trauma. Moderate cranial and mandibular asymmetries were associated with birth trauma. Ten percent of newborns had more than one significant asymmetry.
Conclusions:Asymmetries of the head and neck are very common in normal newborns, and sixteen (16%) of 102 study newborns were found to have torticollis. Such newborns, especially if they sleep supine, are thought to be at risk of developing deformational posterior plagiocephaly. Identification of affected infants may allow early implementation of positioning recommendations or physical therapy to prevent the secondary craniofacial deformations that are part of an increasingly common phenomenon.
