But it was. Fortunately, help was not too far away in neighbouring Singapore.

Tai Yung Fung was a bubbly young girl who thoroughly enjoyed dancing and singing. The youngest amongst three siblings, Yung Fung was the livewire of her family. So when her school holidays arrived in July 2008, her parents expected her voice to resonate their family home in Kulai, Johor in West Malaysia. It did for a while, until she fell ill one day.

Yung Fung’s mother, Mrs Tai Boon Siong, a hair-salon owner, recounts, “We took her to see a doctor after she had a high fever. He prescribed some medication but the next morning, she complained of a stiff neck. We brought her back to the doctor who gave her some painkillers and muscle relaxant.”

Although she slept a lot, after three days, Yung Fung’s condition did not improve. Her concerned parents wanted a second opinion. However, another doctor, a painkilling injection, and a day later, she was back to square one.

Round in circles

Disillusioned, Yung Fung’s parents decided they needed to consult someone with more expertise. So they promptly headed to Johor Bahru, Johor’s main city.

“After the specialist looked at scans of her spinal cord, head and throat, he concluded that nothing was wrong. Muscle relaxants were again prescribed. I looked at my daughter (who was clearly in pain) and became depressed,” shares Mrs Tai.

Back in Kulai, Mrs Tai and her businessman husband took turns to look after Yung Fung. Their subsequent attempts at physiotherapy and traditional massage failed to achieve any results.

At this stage, Yung Fung’s neck was tilted to one side, the pain was excruciating and she was struggling to eat or talk. Mrs Tai was not doing any better herself, fighting hard to put on a brave front.

A silver lining

By October, the new school term had begun but Yung Fung’s condition had deteriorated further.

Mrs Tai recalls, “She was crying most of the time and though her diet had been reduced to soup, she still had trouble eating. She was down to skin and bones.”

“We were desperate but then out of the blue, our prayers were answered when one of Yung Fung’s aunties offered to help. It was through her that we managed to get in touch with a specialist in Singapore. We immediately made arrangements.”

On 6 November 2008, Yung Fung and her parents arrived at KK Women’s and Children’s Hospital. After the initial consultation and examination by an attending specialist, a MRI was ordered. The findings warranted the attention of Dr Seow Wan Tee, Head and Senior Consultant at the hospital’s Paediatric Neurosurgery.

“Although there was a general sense of urgency, at the back of our minds, we felt relieved that at last we were closer to finding out what was wrong with our girl.”

No time to waste

Following CT scans and cervical spine X-rays, Dr Seow recommended Yung Fung be warded. He was fearful that the two-hour road trip home may exacerbate her condition.

Dr Seow discloses, “She presented with torticollis as her neck was twisted into an abnormal position and tilted to one side. She also had difficulty swallowing and was drooling saliva from right side of her mouth. Her tongue was also wasted on the right side, suggesting a 12^th cranial nerve dysfunction.”

Yung Fung had a partial dislocation (subluxation) of the C1 and C2 cervical vertebrae which was causing a rotational deformity of one on the other. With no structural abnormalities discovered, Dr Seow ruled out that the subluxation was the cause of some congenital anomaly of the upper cervical spine which is often, the more common cause.

He explains, “In her case, it is likely that the deformity could be due to some inflammatory process affecting the C1C2 joints and based on the relatively short history, the treatment plan was initially to distract the spine to reduce the rotational deformity.”

After the deformity was reduced from surgery, Dr Seow sought to fix Yung Fung’s head and neck in a normal position to allow recovery and healing. This was to be achieved with a halo device fitted to her head.

 

Time was of the essence and any further delay could result in paralysis. So that same evening, the nine-year old underwent the two-hour spinal distraction surgery.

Constant comfort

After a week’s stay in the hospital, Yung Fung was discharged but not before a vest was fitted to support the halo device.

Dr Seow informs, “She will need to wear the vest for about six weeks and then after removing it, we will assess if her neck has returned to its normal position. If so, then nothing needs to be done. If the torticollis returns again, she may need to go for surgery to fuse the upper part of her cervical spine.”

At her first follow-up in December 2008, scans had not indicated any anomaly of her upper spine, meaning there was a good chance she would not require further surgery.

Mrs Tai declares, “This is really a lesson on how expertise and high technology can make a difference in medicine. Singapore is also lucky to have such well-trained and dedicated doctors.”

She adds, “Dr Seow for instance, took time to explain everything to us and that was reassuring. The nurses and staff of KKH’s International Medical Services were also great. Their help and kindness were a constant comfort to us during a very stressful time. For a foreigner, that means so much.”

Though Yung Fung still has some way to go towards a complete recovery, with her moods up and her parents in close attention, it is likely only a matter of time before this little dancer is back in step, swaying to the music.

Contact

KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Tel: (65) 6394 8888, Email: international@kkh.com.sg, Website: www.kkh.com.sg

Yung Fung’s condition

Torticollis (‘torti’ meaning twisted and ‘collis’ meaning neck) describes the tilting or lateral bending of the head/neck to either side resulting in rotational deformity in the affected cervical vertebrae.

Though not a diagnosis, it is a sign of an underlying condition which may be due to disease, infection, inflammation, trauma or even congenital factors. In Yung Fung’s case, an inflammation was the suspected cause.

Apart from neck pain and the limited motion of the neck due to stiffened muscles, she had also suffered lost of control of the right side of her mouth and tongue. This made eating and drinking difficult and caused her to drool.

Depending on the type of torticollis diagnosed, a variety of treatment regimes may be employed. In many cases, painkillers and muscle relaxants achieve the desired results. However for Yung Fung, surgery to distract the affected vertebrae would provide the best outcome.

After surgery, a halo ring that encircles the head is fitted (with pins) and supported by a halo vest. This device aims to provide positional control and external stabilisation of the cervical spine, vital for recovery. It is also crucial for the management of a variety of other conditions that destabilise the cervical spine.

Although torticollis is not uncommon in small children after birth, it is rare in older children like Yung Fung.