Spasmodic wry-neck must be distinguished from the hysterical variety, which after lasting for weeks, or even months, may pass off completely, but, like other hysterical affections, is liable to recur.
Deviations of the neck simulating torticollis may occur in cervical caries, and in unilateral dislocation of the spine.
The cicatricial contraction of the integument of the neck that results from extensive burns, abscesses, or ulcers, may cause unsightly deformity and fixation of the head in an abnormal attitude, and call for surgical treatment. The contraction which follows the disappearance of a gumma of the sterno-mastoid may also produce a deformity resembling wry-neck.
Injuries
Contusion of the neck may result from a blow or crush, as, for example, the passage of a wheel over the neck, or from throttling, strangling, or hanging. In medico-legal cases the distribution of the discoloration should be carefully noted. When due to throttling, the marks of the fingers may be recognisable, and nail-prints may be present. In cases of strangling, the mark of the cord passes straight round the neck, while in suicidal hanging it is more or less oblique and is higher behind than in front. When due to a direct blow, for example by a fist, the discoloration is limited, while it is usually diffused over the neck when due to the passage of a wheel over the part.
The clinical importance of these injuries depends on the complications that may ensue; for example, extravasation of blood under the cervical fascia may press upon the air-passage and œsophagus to such an extent as to cause interference with breathing and swallowing; the larynx or the trachea may be so grossly damaged that death results immediately from suffocation, or later from gradually increasing œdema causing obstruction of the glottis. If the mucous membrane of the air-passage or the apex of the lung and its investing pleura is torn, emphysema of the connective tissue may develop and spread widely over the body. In contusions of the lower part of the neck the cords of the brachial plexus may be injured.
Fractures of the Hyoid, Larynx, and Trachea.—The hyoid bone, on account of its mobility and the protection it receives from the body of the mandible, is seldom fractured, except in old people in whom the great cornu has become ossified to the body of the bone. It is usually broken either by a direct blow, or by transverse pressure as in garrotting. The fracture is almost always at the junction of the great cornu with the body, and there is marked displacement of the fragments, which may injure the pharyngeal mucous membrane.
The thyreoid and cricoid cartilages are also liable to be fractured in run-over accidents, particularly in old people after calcification or ossification has taken place.
The trachea may be lacerated, or even completely torn from the larynx, by the same forms of injury as produce fracture of the laryngeal cartilages.
The clinical features common to all these injuries are swelling and discoloration; and if the mucous membrane is torn, air may escape into the tissues and produce emphysema. There is always more or less difficulty in breathing, which may amount to actual suffocation, and this may come on immediately, or in the course of a few hours from œdema of the glottis. Blood may pass into the lungs and be coughed up. Swallowing is usually difficult and painful, especially in fracture of the hyoid bone. There is also pain on speaking, the voice is husky and indistinct, and spasmodic coughing is common. When blood has entered the air-passages there is considerable risk of septic pneumonia.