The baby’s neck is crooked, which is a very difficult thing for many parents. When this happens, you have to go to the hospital in a hurry to get checked. Crooked neck, clinically known as “squint”, has a variety of causes and different treatments. To make it easier for you to understand, let’s take five babies as an example. They are: Bebe, Jingjing, Huanhuan, Ying Ying and Nini, that is, Beijing welcomes you. Acute squint Bebe: He had a slight fever and cough for a few days, and suddenly one day after waking up, his head tilted in one direction and he couldn’t move. My mother was very anxious and went straight to the hospital early in the morning. Then the doctor prescribed an X-ray examination of the neck, but unfortunately the examination did not suggest any abnormality in the cervical spine. How did this happen? The diagnosis given by the doctor was an acute squint, and it was recommended to go home and fix the neck with a folded towel, then get enough rest and treat the original cause of the fever and cough. Then, the result was good. The towel was fixed for a day or two and then healed. Although the squinted neck was well, Bebe’s mother still puzzled over it. I believe there are many parents who have also encountered this situation, and now I will tell you the antecedents and consequences of acute squint. Acute squint is clinically, more common, it can be spontaneous or can occur after minor trauma or upper respiratory tract infection. The cause of head tilt is mostly indeterminate. Head tilt may be a muscle spasm caused by lymphadenitis in the neck due to upper respiratory tract infection, pharyngitis, cold, etc. It may also be a slight cervical subluxation caused by relaxation and imbalance of the soft tissues around the cervical spine due to the above-mentioned causes. Clinically, it mainly has the following characteristics, head tilt caused by acute oblique neck, and fixed rotation of the head to one side. Due to the lateral flexion and rotation of the neck, it is difficult to make a diagnosis on cervical spine X-ray, and laboratory tests are mostly normal. The treatment for this condition is mostly fixation of the neck with folded towels and adequate rest, and now there are already neck braces worn by children for better treatment. Early treatment is often managed by primary care physicians. Most children with acute squint resolve within 24 hours. The possibility of rotational displacement should be considered if the deformity persists for more than 24-48 hours. Rotational displacement It has been cold recently and Jingjing got a very heavy upper respiratory infection, throat inflammation, coughing and phlegm, but none of this could stop his playful personality. One day after playing outside all day he suddenly appeared to be unable to move his neck and was fixed in one direction. After a burst of crying and finding his mother, he couldn’t avoid coming to the hospital. After a routine cervical open-ended X-ray, the doctor gave the diagnosis of “atlantoaxial subluxation”. The doctor suggested that Jingjing should undergo traction treatment of the cervical spine, and when they heard that they had to be hospitalized, mom and dad immediately became nervous. Indeed, rotational displacement or rotational subluxation is a more serious form of acute strabismus. This type of strabismus can occur secondary to severe pharyngitis, otitis media, and after head and neck surgery or trauma. In some patients, it is spontaneous. Treatment of rotational subluxation should be done early to avoid lasting fixation and to prevent residual deformity. The first step to know if this is a rotational dislocation is to identify the time of onset and whether there is a history of associated medical problems such as trauma or infection. Sometimes this type of subluxation is complicated by head and neck surgery. Patients with Marfan syndrome are also prone to rotational dislocations. Usually the doctor will examine the area of pressure pain and the range of motion of the neck in detail upon arrival at the hospital. A careful neurological examination will also be performed. Of course, it is worth noting that a tumor of the cervical spine can also present with a sloping neck at the same time. If an infection is suspected, appropriate laboratory tests should be done. So what treatment should be taken after a clear diagnosis? Most of these treatment options require hospitalization. First of all, traction of the neck should be done. If in the early stages, head and neck traction in a sling can be done and most children with strabismus can be relieved by traction. If the deformity persists for more than 1 week without relief, Minerva (continuous cast) plaster immobilization needs to be considered and extended for 2-3 months. For persistent deformities, head ring traction or manual repositioning under general anesthesia may be used. If these measures fail, surgical repositioning and cervical 1-2 fusion may be required. Chronic non-myeloplasia Huanhuan’s neck was never crooked when she was small, and her head movement was particularly flexible and unproblematic, but as she grew up, her parents found that her neck was always crooked in one direction, and her movement was obviously restricted, and the muscles on one side of her neck were particularly pronounced. So the anxious parents brought their baby to the hospital. The doctor asked, “When you were born, did this side of the neck have a bag of fast?” The mother searched all the memories of Huanhuan and could not recall. Then, the doctor asked Huanhuan to “look at the doctor’s finger and move it from side to side, and found that Huanhuan had the possibility of strabismus”. Huanhuan’s parents were puzzled, how could a crooked neck be related to the eyes? The doctor asked Huanhuan to take an X-ray of the cervical spine, and the report indicated that “no abnormal development of the cervical spine was seen”. Then the doctor said, “Consider that it may be a chronic squint caused by strabismus, go to the ophthalmology department for an examination, if it is strabismus, correct the strabismus and then come to the orthopedic department for squint orthopedics. The ophthalmologist examined the patient and found that it was indeed strabismus. So why does strabismus cause strabismus? A strabismic baby needs to tilt his head to one side in order to see the outside world better, and a long time of tilting the head to one side will cause shortening of the sternocleidomastoid muscle on one side and finally cause a chronic non-muscular squint. Oculocutaneous squint belongs to the category of chronic non-muscular squint. About 20% of children with chronic squint are caused by non-muscular causes. (1), X-rays may show such things as congenital cervical fusion or hemivertebrae, and congenital high scapulae. Most congenital cervical fusion and hemivertebral deformities require surgical treatment, and mild high scapular deformities are not appropriate for correction because surgical scarring is often more unsightly than the deformity. Moderate high scapular deformity requires resection of the upper pole of the scapula. For severe high scapular deformity, the scapular deformity must be repositioned. (2), other diseases such as neonatal brachial plexus palsy and spinal cord tumor can also cause diagonal neck, which should be considered in clear diagnosis and treatment. Myelomeningocele is a lump on the left side of Ying’s neck when she was born, and the treatment experience was rather tortuous. After birth, she was brought to the hospital by her parents, and when the doctor felt it, the mass on the left side of her neck was relatively large and not particularly hard, so she was considered to have a high probability of myxedema, and was recommended to have an ultrasound, which indicated that there was a hematoma in the left sternocleidomastoid muscle. The diagnosis was myelomeningocele, and it was suggested that the mass be massaged at home, which gradually became smaller as time went on. What is wrong with the baby? The doctor asked Ying Ying about her medical history and checked her body, and diagnosed her with “myotonic squint”, suggesting that she should continue the massage, and if the result is not good, she will need surgery after one year old. So what is the pathogenesis of myotonic squint? The infant has myotonic neck when first seen. Sometimes a history of breech birth is communicated and a firm mass can be palpated in the sternocleidomastoid muscle. Often only a head tilt and limited neck movement due to contracture of the sternocleidomastoid muscle is seen. An oblique head deformity (asymmetry on both sides of the head) may be present. Developmental hip dysplasia is to be definitively excluded. Even if the hip examination is negative, if the hip is to be evaluated by ultrasound in the neonatal period or, in infants older than 10 weeks, by orthopantomogram of the pelvis. The infant’s oblique neck resolves spontaneously in 90% of cases. The value of distraction physiotherapy is uncertain. In persistent cases, surgical treatment is necessary. The age of surgical correction may be delayed until 3 years of age. Oblique head deformity is a cosmetic problem that rarely persists. Nini did not have any masses in her neck when she was younger, but gradually noticed that her neck was crooked towards one side. Nini has what is likely to be juvenile myotonic squint, some of which occur in childhood. In the adolescent type, there is contracture of both the sternocleidomastoid and clavicular heads of the sternocleidomastoid muscle, causing head tilt and limited neck movement. This type of squint is often persistent and often requires surgery to correct. In cases such as Ying Ying and Nini’s, surgical correction may be required. The correction is done by bipolar release of the sternocleidomastoid muscle. Bipolar release of the sternocleidomastoid muscle is the most effective surgical procedure for the correction of myotonic squint in infancy and childhood.