Differential diagnosis of pediatric torticollis

• Congenital
  — Cervical spine segmentation anomaly
  — Fibromatosis colli
• Acquired
  — Atlanto axial rotatory subluxation from trauma
  — Cervical lymphadenopathy and / or Retropharyngeal abscess
  — Juvenile idiopathic arthritis
  — Posterior fossa tumor or spinal cord tumor

Approach to the differential diagnosis of torticollis:

• If congenital: investigate first with neck ultrasound looking for fibromatosis colli and if this is unremarkable investigate second with cervical spine radiographs looking for a cervical spine segmentation anomaly
• C1-C2 rotatory subluxation is a common finding in trauma patients, patients with head and neck infections such as retropharyngeal abscess, and patients with cervical inflammation such as juvenile idiopathic arthritis
• Finally, consider posterior fossa or spinal cord tumor as an etiology