A treatise on orthopedic surgery . after the eleformity has been corrected. In the well-marked cases of long standing, whether congenitalor acquired, the face on the affected side is shorter and fiatter,the nose and the corner of the mouth and the eyelids even aredrawn downward, and the skull shows evidence of atrophy anddeformity. Secondary distortions also appear in the trunk in chroniccases. These are rotation of the spine to compensate for thelateral distortion of the head and an increase in the dorsal CONGENITAL AND ACQUIRED TORTICOLLIS. 673 kyphosis, round shoulders. Among the minor seco
A treatise on orthopedic surgery . after the eleformity has been corrected. In the well-marked cases of long standing, whether congenitalor acquired, the face on the affected side is shorter and fiatter,the nose and the corner of the mouth and the eyelids even aredrawn downward, and the skull shows evidence of atrophy anddeformity. Secondary distortions also appear in the trunk in chroniccases. These are rotation of the spine to compensate for thelateral distortion of the head and an increase in the dorsal CONGENITAL AND ACQUIRED TORTICOLLIS. 673 kyphosis, round shoulders. Among the minor secondarydeformities upward bowing of the clavicle caused by the tensionof the contracted muscle may be mentioned (Fig. 437). When the deformity is marked or of long standing the headand neck following the compensatory convexity of the cervicalspine are displaced toward the opposite shoulder (Fig. 438).This displacement relaxes in some degree the contracted tissues,consequently the lateral distortion of the head is lessened. Fig. Left torticollis, apparently of congenital origin, showing the secondary distor-tions of head and face. The compensatory deformities that have been indicated areslight in infancy, but they develop in later childhood, for inmany instances the shortened muscle ceases to grow; thus, anoriginal shortening of half an inch, as compared to its fellow,may be increased to two or more inches in later years. Thisfact emphasizes the importance of treatment as soon as may bepossible after distortion is discovered. As has been stated, the important contraction is usually of thesternomastoid muscle, but if the deformity is uncorrected all thelateral tissues become shortened. Typical wryneck caused by shortening of the sternomastoid43 674 OBTEOFEDIC SUBGERY. muscles is by far tlie most common form of congenital torticollis,but occasionally cases are seen in which the head is but slightlyinclined to one side and in which the shortening appears to in-volve the lateral
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Keywords: ., bookauthorwhitmanr, bookcentury1900, bookdecade1910, bookyear1910
