he structures on the affected
side of the neck undergo organic shortening, with the result that the
deformity becomes accentuated. In advanced cases a lateral curvature,
with the convexity towards the normal side, occurs in the cervical
region, the vertebrae becoming wedge-shaped from side to side, and a
compensatory curve may develop in the thoracic region (Fig. 272).

[Illustration: FIG. 272.--Congenital Wry-neck seen from behind to show
scoliosis.]

There is also asymmetry of the head and face, the affected side being
the smaller. The eye on this side lies on a lower level, and is more
oblique than its neighbour, the cheek is flattened, and the mouth
asymmetrical. Instead of the eyebrows and the lips forming parallel
lines, their axes converge towards the side of the contracted muscles
and fasciae.

_Treatment._--While it may be possible when the condition is
recognised during infancy to counteract the tendency to contraction
and deformity by manipulations, massage, and exercises alone, it is
usually necessary to divide the shortened structures as a preliminary
to orthopaedic measures.

Subcutaneous tenotomy--at one time the favourite method of
treatment--has been entirely replaced by the _open operation_, which
admits of all the structures at fault, including the cervical fascia,
being thoroughly divided, without risk of injuring other structures in
the neck. The result of division of the shortened tissues is
seen at once in a marked increase in the interval between the
sterno-clavicular joint and the mastoid process. As in other
deformities, the operation is only a preliminary, although an
essential one, to the treatment by massage, movement, and exercises
which must be persevered with for months, and it may be for years.
When the torticollis attitude has been corrected in childhood, the
asymmetry of the skull disappears.

#Spasmodic wry-neck# is the term applied to a condition in which
clonic contractions of certain muscles produce jerkings of the head.
The muscles most frequently at fault are the sterno-mastoid and
trapezius of one side, and the posterior rotators of the opposite
side. By these muscles the head is pulled into the wry-neck position,
and is at the same time retracted, and there is more or less constant
nodding or jerking of the head.

The condition is usually met with in adults of a neurotic disposition
who are in a depressed state of health, and is due to some lesion, as
yet undiscovered,