The influence of abnormal head posture on facial asymmetry

Aims: The aim of this study was to evaluate the association between the facial asymmetry and the Altered Head Position (AHP), in four patients affected by torticollis (TC). Methods and results: Three patients with diagnosis of ocular TC (OTC) and one patient with diagnosis of congenital muscular TC (MTC), aged between 6 and 15 years, were referred to University of Foggia. All patients underwent a detailed diagnostic check-up based on the collection of the following diagnostic records: anamnestic data; extra-oral and intra-oral clinical examination; panoramic radiograph, latero-lateral and postero-anterior teleradiographs with their cephalograms; posture-stabilometric examination; electromyographic screening. Clinically, each patient showed facial asymmetry, although in the OTC patients the head resulted deviated to the contralateral side of the affected eye, while in the MTC patient it was deviated to the ipsilateral side of the affected muscle. Moreover, a decreased growth of the hemimandible on the ipsilateral side to the head deviation was found in all patients, with the prevalent involvement of the mandibular body. Functionally, an asymmetric jaw muscular activation was also found in all patients, both at rest and during function, as confirmed by electromyographic results. Conclusion: The clinical, radiographic and electromyographic findings of the present paper confirmed the influence of the AHP on the development of facial asymmetry, in patients with TC.