Torticollis and rotatory atlantoaxial dislocation: A clinical review.

Rotatory atlantoaxial instability can manifest as an acute episode following subtle or minor injury or even following a gentle tap on head in young children and can manifest as a painless deformity of the head. Goel technique of direct surgical opening of the atlantoaxial facet joint, manual manipulation of the facets can lead to reduction of rotatory atlantoaxial dislocation and recovery from torticollis. Torticollis can be a protective natural phenomenon in response to atlantoaxial instability and related basilar invagination. Only atlantoaxial fixation can lead to immediate postoperative reduction of torticollis. Spasmodic torticollis related to muscle hyperactivity is unrelated to atlantoaxial instability.