Sternomastoid Tumor of Infancy

Sternomastoid tumor of infancy, also known as congenital muscular torticollis, is a condition that affects the neck muscles of infants. It is characterized by a lump or mass in the muscle of the neck, specifically in the sternomastoid muscle.

The sternomastoid muscle is located on either side of the neck and connects the sternum (breastbone) and clavicle (collarbone) to the mastoid process of the skull. This muscle is responsible for the rotation and flexion of the neck.

Types

Different types of sternomastoid tumors of infancy and their details.

1. Fibromatosis Colli: Fibromatosis colli is the most common type of sternomastoid tumor in infancy. It occurs due to the abnormal growth of fibrous tissue in the sternomastoid muscle. This can lead to the development of a mass or lump in the neck, which can cause the head to tilt or turn to one side. This type of tumor is typically benign and can be treated with physical therapy or surgery.
2. Cystic Hygroma: Cystic hygroma is a type of sternomastoid tumor of infancy that occurs due to the abnormal growth of lymphatic vessels in the neck. This can lead to the development of a fluid-filled sac or cyst in the neck, which can cause the head to tilt or turn to one side. This type of tumor can be benign or malignant, and treatment may involve surgical removal.
3. Hemangioma: Hemangioma is a type of sternomastoid tumor of infancy that occurs due to the abnormal growth of blood vessels in the neck. This can lead to the development of a red or purple mass or lump in the neck, which can cause the head to tilt or turn to one side. This type of tumor is typically benign and may resolve on its own or with medical intervention.
4. Lymphatic Malformation: Lymphatic malformation is a type of sternomastoid tumor of infancy that occurs due to the abnormal growth of lymphatic vessels in the neck. This can lead to the development of a mass or lump in the neck, which can cause the head to tilt or turn to one side. This type of tumor can be benign or malignant, and treatment may involve surgical removal.
5. Neurofibroma: Neurofibroma is a type of sternomastoid tumor of infancy that occurs due to the abnormal growth of nerve tissue in the neck. This can lead to the development of a mass or lump in the neck, which can cause the head to tilt or turn to one side. This type of tumor is typically benign and can be treated with surgery or observation.
6. Lipoma: Lipoma is a type of sternomastoid tumor of infancy that occurs due to the abnormal growth of fatty tissue in the neck. This can lead to the development of a soft mass or lump in the neck, which can cause the head to tilt or turn to one side. This type of tumor is typically benign and may resolve on its own or with medical intervention.

Causes

There are several potential causes for sternomastoid tumors of infancy, including:

1. Birth Trauma: Sometimes, a difficult birth or delivery can cause injury to the neck muscles, leading to the sternomastoid tumor of infancy.
2. Abnormal Fetal Positioning: If an infant is positioned in an awkward or abnormal position in the uterus during pregnancy, this can cause pressure on the neck muscles, leading to the sternomastoid tumor of infancy.
3. Genetic Factors: Some research suggests that certain genetic factors may predispose infants to developing sternomastoid tumors in infancy.
4. Intrauterine Fibrosis: Intrauterine fibrosis is a condition where scar tissue forms in the fetus’s neck muscles, leading to the sternomastoid tumor of infancy.
5. Musculoskeletal Abnormalities: Musculoskeletal abnormalities, such as scoliosis or hip dysplasia, can contribute to the development of sternomastoid tumors of infancy.
6. Infections: Certain infections, such as ear infections or mastoiditis, can lead to the development of sternomastoid tumors in infancy.
7. Vascular Abnormalities: Some infants with sternomastoid tumors of infancy have abnormalities in the blood vessels in their necks, which can contribute to the condition.
8. Abnormalities in the Nervous System: Abnormalities in the nervous system, such as nerve damage or brain injuries, can lead to sternomastoid tumors of infancy.
9. Plagiocephaly: Plagiocephaly is a condition where an infant’s skull becomes flattened or misshapen, which can contribute to the development of a sternomastoid tumor of infancy.
10. Premature Birth: Premature infants may be more susceptible to developing sternomastoid tumors of infancy, as their neck muscles may not be fully developed.
11. Multiple Births: Twins or other multiple births may increase the risk of developing a sternomastoid tumor of infancy.
12. Maternal Drug Use: Certain medications or drugs used during pregnancy may increase the risk of developing a sternomastoid tumor of infancy.
13. Maternal Infection: Maternal infections, such as rubella or toxoplasmosis, may increase the risk of developing sternomastoid tumor of infancy.
14. Maternal Smoking: Smoking during pregnancy may increase the risk of developing a sternomastoid tumor in infancy.
15. Abnormalities in Fetal Development: Some infants with sternomastoid tumors of infancy have abnormalities in their fetal development, such as a cleft lip or palate.
16. Abnormalities in the Muscles: Some infants with sternomastoid tumors of infancy have abnormalities in their muscle development, which can contribute to the condition.
17. Abnormalities in the Skeleton: Abnormalities in the development of the skeleton, such as spinal deformities, can contribute to the development of sternomastoid tumors in infancy.
18. Craniofacial Abnormalities: Craniofacial abnormalities, such as a small jaw or a high palate, can contribute to the development of sternomastoid tumors in infancy.
19. Nutritional Deficiencies: Certain nutritional deficiencies, such as vitamin D deficiency, may increase the risk of developing a sternomastoid tumor in infancy.
20. Environmental Toxins: Exposure to certain environmental toxins, such as lead or mercury, may increase the risk of developing sternomastoid

Symptoms

It occurs when the sternocleidomastoid muscle, which runs from behind the ear to the collarbone and breastbone, becomes tight or shortened, causing the head to tilt to one side and the chin to point in the opposite direction. In this article, we will discuss the 20 symptoms of sternomastoid tumors of infancy in detail.

1. Head tilt: The most common symptom of sternomastoid tumors of infancy is head tilt to one side. This is caused by the shortening or tightening of the sternocleidomastoid muscle.
2. Limited range of motion: Infants with sternomastoid tumors of infancy may have limited range of motion in their neck, which can make it difficult for them to turn their head.
3. Asymmetrical head shape: The constant head tilt can cause an asymmetrical head shape, with flattening on one side and bulging on the other.
4. Facial asymmetry: The asymmetrical head shape can also cause facial asymmetry, with one side of the face appearing different from the other.
5. Neck mass: In some cases, a firm, palpable mass may be present in the affected sternocleidomastoid muscle.
6. Neck pain: Infants with sternomastoid tumors of infancy may experience neck pain or discomfort.
7. Irritability: The pain and discomfort associated with sternomastoid tumors of infancy can cause irritability and fussiness in infants.
8. Poor sleep: Infants may have difficulty sleeping due to the discomfort caused by sternomastoid tumors of infancy.
9. Feeding difficulties: The head tilt and limited range of motion can make it difficult for infants to feed, which can lead to poor weight gain.
10. Speech delay: In severe cases, sternomastoid tumors of infancy can cause speech delay if the head tilt and limited range of motion affect the infant’s ability to hear and communicate.
11. Hearing loss: In rare cases, sternomastoid tumors of infancy can cause hearing loss if the head tilt and limited range of motion affect the infant’s ability to hear.
12. Eye problems: The head tilt can cause eye problems, such as strabismus (crossed eyes) or amblyopia (lazy eye), if left untreated.
13. Torticollis: The term “torticollis” refers to the twisted or tilted neck position caused by sternomastoid tumors of infancy.
14. Shoulder asymmetry: The head tilt can cause asymmetry in the shoulders, with one shoulder appearing higher than the other.
15. Back pain: In severe cases, sternomastoid tumors of infancy can cause back pain or discomfort due to the altered posture caused by the head tilt.
16. Hip dysplasia: The altered posture caused by the head tilt can also lead to hip dysplasia, a condition where the hip joint is not properly formed.
17. Scoliosis: The altered posture can also lead to scoliosis, a condition where the spine curves to one side.
18. Developmental delay: Infants with severe sternomastoid tumors of infancy may experience a developmental delay if the head tilt and limited range of motion affect their motor skills.
19. Behavioral problems: The pain and discomfort associated with sternomastoid tumors of infancy can cause behavioral problems, such as irritability and difficulty concentrating.
20. Emotional distress: Older children with untreated sternomastoid tumors of infancy may experience emotional distress due to the cosmetic deformities caused by the condition.

Diagnosis

The diagnosis of sternomastoid tumors of infancy involves a combination of clinical evaluation and imaging studies. Here are common tests and procedures that may be used to diagnose and evaluate the condition:

1. Physical examination: A thorough examination of the affected area is the first step in the diagnosis of sternomastoid tumors of infancy. The doctor will look for any visible signs of swelling or lumps in the sternomastoid muscle.
2. Medical history: The doctor will ask about the baby’s medical history, including any complications during birth or any other medical conditions.
3. Ultrasound: An ultrasound is a non-invasive imaging test that uses sound waves to create images of the inside of the body. It can be used to evaluate the size and location of the tumor.
4. X-ray: An X-ray may be used to rule out other conditions, such as bone abnormalities or fractures.
5. MRI: Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to create detailed images of the body. It can provide more detailed information about the size and location of the tumor.
6. CT scan: A computed tomography (CT) scan uses X-rays and computer technology to create detailed images of the body. It may be used to evaluate the tumor and surrounding structures.
7. Blood tests: Blood tests are not typically used to diagnose sternomastoid tumors of infancy, but they may be ordered to rule out other medical conditions.
8. Biopsy: A biopsy involves removing a small sample of tissue from the tumor and examining it under a microscope. It may be used to confirm the diagnosis of sternomastoid tumors and rule out other conditions.
9. Fine-needle aspiration: Fine-needle aspiration involves inserting a thin needle into the tumor and removing a small sample of fluid or tissue. It may be used to evaluate the tumor and rule out other conditions.
10. Electromyography: Electromyography (EMG) is a test that measures the electrical activity of muscles. It may be used to evaluate the function of the sternomastoid muscle.
11. Nerve conduction studies: Nerve conduction studies are tests that evaluate the function of the nerves that control the muscles in the neck.
12. Ophthalmologic evaluation: An ophthalmologic evaluation may be recommended to rule out any visual problems that may be associated with sternomastoid tumors.
13. Referral to a specialist: A referral to a specialist, such as a pediatric orthopedic surgeon or a physical therapist, may be recommended for further evaluation and treatment.
14. Range of motion assessment: A range of motion assessment evaluates the ability of the neck to move in different directions. It may be used to assess the severity of the condition.
15. Postural assessment: A postural assessment evaluates the alignment of the neck and spine. It may be used to identify any abnormalities that may be contributing to the condition.
16. Gait analysis: Gait analysis evaluates the way the baby moves when walking or crawling. It may be used to identify any abnormalities in muscle function.
17. Visual assessment: A visual assessment evaluates the baby’s ability to track objects

Treatment

There are various treatments available for sternomastoid tumors of infancy. Here is a list of treatments, along with details on each treatment.

1. Physical therapy: This is often the first line of treatment for sternomastoid tumors of infancy. Physical therapy involves gentle stretching and strengthening exercises to improve the range of motion in the neck.
2. Massage therapy: Massage therapy can help to relax the contracted muscle and reduce pain and discomfort.
3. Heat therapy: Applying heat to the affected area can help to improve blood flow and reduce muscle tension.
4. Cold therapy: Applying cold to the affected area can help to reduce pain and inflammation.
5. Electrical stimulation: This treatment involves using a small electrical current to stimulate the muscle and promote healing.
6. Ultrasound therapy: This treatment involves using high-frequency sound waves to promote healing and reduce inflammation.
7. Acupuncture: Acupuncture involves inserting thin needles into specific points on the body to stimulate healing.
8. Chiropractic care: Chiropractic care involves manipulating the spine to improve alignment and reduce tension in the neck muscles.
9. Craniosacral therapy: This treatment involves using gentle touch to manipulate the bones of the skull and spine to improve alignment and reduce tension in the neck muscles.
10. Myofascial release: This treatment involves using gentle pressure to release tension in the fascia, the connective tissue that surrounds muscles.
11. Osteopathic manipulation: This treatment involves using gentle manipulation of the joints and tissues to improve alignment and reduce tension in the neck muscles.
12. Trigger point therapy: This treatment involves using pressure to release tension in specific trigger points in the muscle.
13. Kinesiology taping: This treatment involves applying tape to the affected area to provide support and improve alignment.
14. Stretching exercises: Stretching exercises can help to improve the range of motion in the neck and reduce tension in the muscle.
15. Strengthening exercises: Strengthening exercises can help to improve the strength and endurance of the neck muscles.
16. Splinting: In some cases, a splint may be used to keep the baby’s head in a neutral position and prevent further tilting.
17. Surgery: In rare cases, surgery may be necessary to release the contracted muscle and improve the range of motion in the neck.
18. Botox injections: Botox injections can be used to relax the contracted muscle and reduce pain and discomfort.
19. Medications: Pain medications or muscle relaxants may be prescribed to relieve pain and reduce muscle tension.
20. Parent education: Parents can be educated on ways to prevent further tilting of the head, such as changing the baby’s position frequently and using a firm mattress in the crib.

Medications

Drugs that have been used to treat this condition and their details.

1. Ibuprofen: This nonsteroidal anti-inflammatory drug (NSAID) can help to reduce inflammation and relieve pain associated with sternomastoid tumors of infancy.
2. Acetaminophen: This pain reliever can help to reduce discomfort associated with sternomastoid tumors of infancy.
3. Morphine: This strong opioid pain reliever may be prescribed for severe pain associated with sternomastoid tumors of infancy.
4. Fentanyl: This synthetic opioid pain reliever may also be prescribed for severe pain associated with sternomastoid tumors of infancy.
5. Gabapentin: This anticonvulsant drug may be used to help manage nerve pain associated with sternomastoid tumors of infancy.
6. Baclofen: This muscle relaxant may be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
7. Tizanidine: This muscle relaxant may also be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
8. Diazepam: This benzodiazepine drug may be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors in infancy.
9. Clonazepam: This benzodiazepine drug may also be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
10. Prednisone: This corticosteroid drug may be prescribed to help reduce inflammation and relieve pain associated with sternomastoid tumors of infancy.
11. Dexamethasone: This corticosteroid drug may also be prescribed to help reduce inflammation and relieve pain associated with sternomastoid tumors of infancy.
12. Methocarbamol: This muscle relaxant may be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
13. Carisoprodol: This muscle relaxant may also be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
14. Cyclobenzaprine: This muscle relaxant may be prescribed to help relax the sternomastoid muscle and reduce the severity of symptoms associated with sternomastoid tumors of infancy.
15. Topiramate: This anticonvulsant drug may be used to help manage nerve pain associated with sternomastoid tumors of infancy.
16. Pregabalin: This anticonvulsant drug may also be used to help manage nerve pain associated with sternomastoid tumors of infancy.
17. Lidocaine: This local anesthetic may be used to provide temporary pain relief for sternomastoid tumors of infancy.
18. Bupivacaine: This local anesthetic may also be used to provide temporary pain relief for sternomastoid tumors of infancy.
19. Botulinum toxin type A: This neurotoxin may be injected into the sternomastoid muscle

In conclusion, there are many treatments available for sternomastoid tumors in infancy. Physical therapy, massage therapy, heat therapy, cold therapy, electrical stimulation, ultrasound therapy, acupuncture, chiropractic care, craniosacral therapy, myofascial release, osteopathic manipulation, trigger point therapy, kinesiology taping, stretching exercises, strengthening exercises, splinting, surgery, Botox injections, medications, and parent education can all be effective in treating this condition.

References