Photogrammetry protocol in babies with congenital torticollis: part 1 – inter-arch intraoral assessment

Torticollis is defined as an imbalance of the sternocleidomastoid muscle (SCM), with less extension of the neck, resulting in a preference to turn the head more from one side to the other. The characteristics frequently found are: ear contralateral to the torticollis displaced forward, facial asymmetry, and contralateral occipital flattening, as well as a smaller ipsilateral eye, causing misalignment of the eyes. This condition can also cause mandibular inclination (MI), in the frontal plane, with a difference in opening between the maxilla and mandible from one side or the other. The diagnosis and treatment of torticollis are routinely carried out by the physiotherapist and the diagnosis of this mandibular inclination is traditionally through visual examination. This assessment of mandibular inclination, carried out by the dentist, in an objective manner, can contribute to the diagnosis and also to the monitoring of proposed treatments that should reduce mandibular asymmetries. The objective of this study was to create a protocol for objective measurement of the distance between the maxilla and mandible, on the right and left sides, using photogrammetry, to detect whether mandibular inclination can be observed by the shorter inter-arch distance on the side corresponding to the torticollis. Case reports of two babies (1 baby aged 9 months and another aged 1 year and 1 month), diagnosed with congenital torticollis. Photogrammetry was carried out: the babies were positioned on a dental stretcher and photographed in maximum opening, intermediate, and closing positions. Using the photos and the IMAGE J program, measurements between the maxilla and mandible were taken (see photogrammetry description). Results: The measurement protocol used in both babies confirmed the greater mandibular inclination by approaching the hemi-arch corresponding to the side of the torticollis, compared to the opposite side. Objective measurement of mandibular inclination can be part of the timely diagnosis for congenital torticollis. Studies with an adequate sample size and methodology are necessary to confirm this diagnostic tool.