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Tobing SDAL, Hendriarto A, Wikanjaya R. Conservative approach for treatment of Grisel's syndrome after resection of lympahadenitis tuberculosis of the neck: A rare case report. Int J Surg Case Rep 2021; 88:106452. [PMID: 34653893 PMCID: PMC8521141 DOI: 10.1016/j.ijscr.2021.106452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Grisel's syndrome is a rare condition characterized by nontraumatic rotatory subluxation of the atlantoaxial joint, which was caused by previous inflammation around the head and neck. It is usually seen in children and signed as torticollis. There was no consensus for management, yet early diagnosis and treatment is paramount. PRESENTATION OF CASE A 5-year-old girl came to outpatient clinic complaining of wry neck 1 day after surgical excision of her TB lymphadenitis and got worsen by time. There was no history of trauma around the neck. Examination under general anesthesia and CT scan revealed acquired severe torticollis consistent with Grisel's Syndrome Fielding type 3 accompanied by TB lymphadenitis, and TB myositis of the neck. Manipulation under general anesthesia and immobilization using Minerva cast followed by Lerman Cervicothoracal Osthosis was conducted. DISCUSSION This patient was diagnosed with Grisel's syndrome and underwent conservative treatment consisting of reduction under general anesthesia and immobilization using Minerva cast for 6 weeks. The patient was then applied Lherman Cervical Thoracic Orthosis (CTO) halo brace for another 3 months. Anti-tuberculous drug was given to control tuberculous infection. Eight months follow-up showed neither residual deformity, neck pain, nor movement limitation of the neck. CONCLUSION Grisel's syndrome has excellent result that is treated with conservative treatment using reduction under general anesthesia and Minerva cast.
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Affiliation(s)
- Singkat Dohar A L Tobing
- Orthopaedic and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andra Hendriarto
- Orthopaedic and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rio Wikanjaya
- Orthopaedic and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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Atlantoaxial Rotatory Fixation after Microtia Reconstruction Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3760. [PMID: 34476155 PMCID: PMC8382324 DOI: 10.1097/gox.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Nontraumatic atlantoaxial rotatory fixation after microtia reconstruction surgery is a rare complication. Intraoperative cervical hyperextension and/or excessive rotation and postoperative inflammation have been reported as causes of atlantoaxial rotatory fixation. We herein describe cases of atlantoaxial rotatory fixation after microtia reconstruction surgery. Methods This was a retrospective study of 80 patients (165 surgeries) who underwent microtia reconstruction surgery in Dokkyo Medical University Hospital between April 2006 and December 2012. The patient- and operation-related variables were obtained from medical charts. Neck radiographs and computed tomography scans of patients with atlantoaxial rotatory fixation were evaluated to check for cervical spine abnormalities. Results Five cases of atlantoaxial rotatory fixation after microtia reconstruction surgery were recorded. Three of these five cases were diagnosed with Klippel-Feil syndrome after the onset of atlantoaxial rotatory fixation. No significant difference was found in the operative duration and other variables between patients with atlantoaxial rotatory fixation and those without. All patients immediately underwent conservative treatment and showed complete recovery and no recurrences. Conclusions Although atlantoaxial rotatory fixation is a rare complication, surgeons should consider it in patients with neck problems following microtia reconstruction surgery. A patient with microtia may have unrecognized Klippel-Feil syndrome. Patients with Klippel-Feil syndrome are more likely to develop atlantoaxial rotatory fixation, which may have severe consequences. Thus, it is crucial to preoperatively identify Klippel-Feil syndrome with neck radiography and to detect atlantoaxial rotatory fixation at the earliest.
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Unusual presentation of an unusual disease: A very delayed diagnosis of Grisel's syndrome. Turk J Phys Med Rehabil 2021; 67:259-263. [PMID: 34396079 PMCID: PMC8343148 DOI: 10.5606/tftrd.2021.4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/26/2019] [Indexed: 11/29/2022] Open
Abstract
Grisel’s syndrome (GS) is a rare syndrome which refers only to non-traumatic atlantoaxial subluxation. This syndrome predominantly occurs in young children following an upper respiratory infection or otolaryngologic procedures. An eight-year-old girl with a delayed diagnosis of GS was admitted to our outpatient clinic with complaints of painful torticollis and neck stiffness. Three-dimensional computed tomography revealed rotatory atlantoaxial subluxation. After consulting with the neurosurgery department, the patient underwent surgery. The significance of this patient was that she was unable to be diagnosed early and atlantoaxial subluxation remained hidden for five years without any complications. In conclusion, this rare case highlights the importance of delayed diagnosis of GS and clinicians should be aware of this syndrome.
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Spinnato P, Zarantonello P, Guerri S, Barakat M, Carpenzano M, Vara G, Bartoloni A, Gasbarrini A, Molinari M, Tedesco G. Atlantoaxial rotatory subluxation/fixation and Grisel's syndrome in children: clinical and radiological prognostic factors. Eur J Pediatr 2021; 180:441-447. [PMID: 33064218 DOI: 10.1007/s00431-020-03836-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/25/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children. The aim of our study is to investigate all possible clinical and radiological prognostic factors in children with AARS/F. We retrospectively reviewed all cervical spine CT scans of children with AARS/F treated in our Hospital over the last 15 years. AARS/F was classified according to Fielding and Hawkins classification and C1-C2 rotation-degree was calculated. Moreover, two orthopedic surgeons reviewed all clinical reports of these children. All patients were conservatively treated (cervical traction/neck collar). An early recovery was considered in patients with complete clinical/radiological healing at 3 months follow-up, while a late recovery was considered in patients with disease persistence or relapse at 3 months follow-up or earlier. Fifty-five patients with diagnosis of AARS/F were included in the study (mean age = 8.5 years old - 25F, 30M). In 9/55 subjects (16.4%), a late recovery was observed. The presence of a concomitant infection or inflammation in the head and neck region (Grisel's syndrome) was significantly associated with a late recovery (p < .001). Also, the type of AARS/F (p = .019), according to the Fielding and Hawkins classification, and C1-C2 rotation-degree (p = .027) were significantly correlated with the recovery time.Conclusion: In patients with AARS/F, the presence of a concomitant infection/inflammation in the head and neck region is the most important prognostic factor and it is associated with a late recovery. The Fielding and Hawkins classification and C1-C2 rotation-degree well correlate with patients' recovery time. What is Known: • Atlantoaxial rotatory subluxation/fixation (AARS/F) is a rare cause of torticollis in children and CT is the most useful imaging tool for diagnosis and classification of AARS/F. • Conservative treatments are effective in the majority of pediatric patients with AARS/F. What is New: • The presence of a concomitant infection/inflammation in the head and neck region associated with AARS/F (Grisel's syndrome) is the most important prognostic factor and it is associated with a late recovery. • C1-C2 rotation-degrees, as well as Fielding and Hawkins classification system, well correlate with patients' recovery time.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.
| | - Paola Zarantonello
- Department of Pediatric Orthopaedics and Traumatology, IRCCS Istituto Ortopedico, Rizzoli, Bologna, Italy
| | - Sara Guerri
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Massimo Barakat
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carpenzano
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Giulio Vara
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Molinari
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via GC Pupilli n 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Affiliation(s)
- Eric McGrath
- Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Yamini Jadcherla
- Children's Hospital of Michigan, Detroit, MI, USA
- Pediatric Education Department, Residency Program, Children's Hospital of Michigan, Detroit, MI, USA
| | - Jaclyn Held
- Children's Hospital of Michigan, Detroit, MI, USA
- Pediatric Education Department, Residency Program, Children's Hospital of Michigan, Detroit, MI, USA
| | - Jocelyn Y Ang
- Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
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Grisel's Syndrome in Children: Two Case Reports and Systematic Review of the Literature. Case Rep Pediatr 2020; 2020:8819758. [PMID: 33274097 PMCID: PMC7676959 DOI: 10.1155/2020/8819758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Objective. Grisel's syndrome is a rare syndrome characterized by nontraumatic rotatory subluxation of the atlantoaxial joint. It usually affects children and typically presents with torticollis after ear, nose, and throat (ENT) surgery or head and neck infections. In the pediatric literature, there is only a small amount of available data; moreover, no systematic review has been previously done with focus on the pediatric population. We report our experience of two cases, and we provide a systematic review on Grisel's syndrome in children in order to offer a deeper insight about its clinical presentation, its current diagnosis, and principles of treatment. Case Reports and Review. We describe two boys of 9 and 8 years old, who developed atlantoaxial subluxation after adenoidectomy. Considering the early diagnosis, a conservative treatment was chosen, with no recurrence and no sequelae at follow-up. We identified 114 case reports, of which 90 describe children, for a total of 171 pediatric patients. Of the 154 cases in which cause was reported, 59.7% presented a head and neck infection and 35.7% had previous head and neck surgery. There is no sex prevalence (49.7% males versus 50.2% females). Mean delay in diagnosis is 33 days. Eight % of the patients had neurological impairment of the 165 cases which mentioned treatment, 96% underwent a conservative treatment, of whom the 8.8% recurred with the need of surgery. As a whole, 12% underwent surgery as a first- or second-line treatment. 3 6% of the patients whose follow-up was reported developed a sequela, minor limitation of neck movement being the most frequent. Conclusion. Grisel's syndrome should be suspected in children with painful unresponsive torticollis following ENT procedures or head and neck inflammation. CT scan with 3D reconstruction is the gold standard for diagnosis, allowing the identification of the subluxation and the classification according to the Fielding–Hawkins grading system. Surgical treatment is indicated in case of high-grade instability or failure of conservative treatment. Review of the literature shows how early diagnosis based on clinical and radiological evaluation is crucial in order to avoid surgical treatment and neurologic sequelae.
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Matos TD, Pinheiro RP, Costa HRT, Defino HLA. Rotational dislocation C1-C2 after otoplasty under local anesthesia. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:237-239. [PMID: 33100775 PMCID: PMC7546050 DOI: 10.4103/jcvjs.jcvjs_66_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/08/2022] Open
Abstract
Non-traumatic rotational atlantoaxial subluxation (NTARS) is rare and mostly reported after infection of the upper respiratory tract and named Grisel's syndrome. NTARS has also been reported after head-and-neck surgery, but it is extremely rare after otoplasty. A case of NTARS after bilateral otoplasty is reported under local anesthesia, a 15-year-old female being presented with painful torticollis. The diagnosis of atlantoaxial rotatory subluxation was performed using radiographs and computed tomography 2 weeks after the surgery. Closed reduction was performed by traction of the head and transoral direct pressure over an anterior dislocated C1 mass. The reposition of the joint was achieved, but it was very unstable, and it was not possible to keep the reduction. Open posterior reduction and posterior C1–C2 arthrodesis were performed followed by the use of a soft collar during 3 months.
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Affiliation(s)
- Thiago Dantas Matos
- Department of Orthopedics and Traumatology Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Romulo Pedroza Pinheiro
- Department of Orthopedics and Traumatology Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Herton Rodrigo Tavares Costa
- Department of Orthopedics and Traumatology Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Helton Luiz Aparecido Defino
- Department of Orthopedics and Traumatology Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Al-Driweesh T, Altheyab F, Alenezi M, Alanazy S, Aldrees T. Grisel's syndrome post otolaryngology procedures: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 137:110225. [PMID: 32658805 DOI: 10.1016/j.ijporl.2020.110225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures. METHOD We conducted a search of MEDLINE/PubMed for articles published through January 2020 utilizing the following terms: Grisel's syndrome, Grisel syndrome, and atlantoaxial subluxation alone and in combination with other terms like ENT, otolaryngology, head & neck, tonsillectomy, adenoidectomy, adenotonsillectomy, mastoidectomy, tympanoplasty, and tympanomastoidectomy. We included English-language cases that occurred after surgical procedures and contained the following data: age, onset, common presenting symptoms, diagnostic approach, management options, and the presence of complications. RESULT We found 39 papers that met our criteria. Most cases occurred after adenotonsillectomy with or without ventilation tube insertion (55.6%). The majority of the affected population was the pediatric age group, and the main presenting symptom was torticollis that presents as early-onset. In regard to management, most of the cases were treated with medical therapy with or without adjunctive measures (e.g., a cervical collar). No neurological complications were recorded except in one case that was treated with no long term sequel. CONCLUSION Grisel's syndrome is a rare complication that occurs after otolaryngology procedures and can result in serious neurological complications and death. A high index of suspicion is an important factor for early diagnosis and management to prevent such complications. In most cases, conservative management is successful with a good prognosis.
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Affiliation(s)
- Turki Al-Driweesh
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi Arabia.
| | - Fatemah Altheyab
- Resident, Department of Otolaryngology-Head and Neck Surgery, King Saud Hospital, Unayzah, AlQassim, Saudi Arabia
| | - Mazyad Alenezi
- Consultant Otolaryngology-Head and Neck Surgery, Assistant Professor, Otolaryngology-Head and Neck Surgery Department, College of Medicine, Qassim University, Buriyadh, Qassim, Saudi Arabia
| | - Sultan Alanazy
- Assistant Professor of Otolaryngology-Head and Neck Surgery, Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia
| | - Turki Aldrees
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
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Cucuzza ME, D'Ambra A, Evola FR, Greco F, Smilari P. Grisel syndrome, sigmoid sinus thrombosis and rheumatic carditis: Case report of a rare association. Int J Pediatr Otorhinolaryngol 2020; 129:109774. [PMID: 31734565 DOI: 10.1016/j.ijporl.2019.109774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022]
Abstract
Grisel's syndrome (GS) is a non traumatic atlanto-axial rotatory subluxation of C1-C2 joint. A six year old girl, 20 days after an episode of fever, developed a torticollis and a 3/6 heart murmur. The echocardiography showed a Rheumatic Carditis. The Brain and cervical spine Magnetic resonance imaging (MRI) and the Computerized Tomography (CT) showed rotary dislocation of C1-C2 vertebrae, compatible with GS, and cerebral venous thrombosis (CVT). An antibiotic therapy, Prednisone and a low molecular weight heparin for 7 days was prescribedfollowed by an oral anticoagulant for 6 months. After a month the MRI showed a reduction of the dislocation and cerebral venous recanalization.
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Affiliation(s)
- Maria Elena Cucuzza
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Angela D'Ambra
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | | | - Filippo Greco
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Pierluigi Smilari
- Pediatric Clinic, Departmente of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Falsaperla R, Piattelli G, Marino S, Marino SD, Fontana A, Pavone P. Grisel's syndrome caused by Mycoplasma pneumoniae infection: a case report and review of the literature. Childs Nerv Syst 2019; 35:523-527. [PMID: 30209598 DOI: 10.1007/s00381-018-3970-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process involving the upper neck. Torticollis, neck pain, and reduced neck mobility are the main clinical signs of presentation. Predisposing factors are trauma, hyperlaxity of the transverse and alar ligaments of the atlantoaxial joints, and surgical interventions carried out in this area. Several viral and bacterial pathogens have been reported as causative events of Grisel's syndrome, including Epstein-Barr virus, Kawasaki disease, Streptococcus pyogenes, Staphylococcus aureus, and other infectious agents. Grisel's syndrome linked to Mycoplasma pneumoniae infection as the trigger has not previously been reported. Mycoplasma pneumoniae is a small prokaryotic microbe and a frequent etiologic factor of respiratory tract infections and, less frequently, of extrapulmonary body organs. The recognition of the Grisel's syndrome is based on clinical and neuroradiological investigations, and early diagnosis and specific treatment are crucial to the successful outcome of the disease. RESULTS We report the case of an 8-year-old girl with Grisel's syndrome caused by an upper respiratory tract infection due to Mycoplasma pneumoniae. Diagnostic suspicion and treatment of Grisel's syndrome were established quickly by anamnestic and clinical data and confirmed by radiological findings. The girl was immediately treated with specific antibiotic therapy and cervical immobilization, thus preventing the most dangerous complications of the disorder. CONCLUSION Mycoplasma pneumoniae, among the other infectious agents, may be cause of scute torticollis and Gresel's syndrome.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Gianluca Piattelli
- Department of Neurosurgery, University Hospital "Giannina Gaslini", Genoa, Italy
| | - Silvia Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Simona Domenica Marino
- Pediatric Emergency Department, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alessandra Fontana
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Piero Pavone
- Department of Pediatrics, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy.
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
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Iaccarino C, Francesca O, Piero S, Monica R, Armando R, de Bonis P, Ferdinando A, Trapella G, Mongardi L, Cavallo M, Giuseppe C, Franco S. Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:279-288. [PMID: 30610334 DOI: 10.1007/978-3-319-62515-7_40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. CASE DESCRIPTION Five children with Fielding type I-III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal-occipital-mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. CONCLUSION In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel's syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery-Neurotraumatology Unit, University Hospital of Parma, Parma, Italy. .,Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Ormitti Francesca
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Spennato Piero
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Rubini Monica
- Division of Paediatric General and Emergency Care Unit, Children's Hospital of Parma, Parma, Italy
| | - Rapanà Armando
- Neurosurgery Unit, Lorenzo Bonomo Hospital, Andria, Italy
| | - Pasquale de Bonis
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Aliberti Ferdinando
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
| | - Giorgio Trapella
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Lorenzo Mongardi
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Michele Cavallo
- Neurosurgery Department, University Hospital of Ferrara, Ferrara, Italy
| | - Cinalli Giuseppe
- Neurosurgery Department, Azienda Ospedaliera di Rilievo Nazionale "Santobono-Pausilipon-Annunziata" Children's Hospital, Naples, Italy
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Sakaida H, Akeda K, Sudo A, Takeuchi K. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children. Patient Saf Surg 2017; 11:5. [PMID: 28184249 PMCID: PMC5289022 DOI: 10.1186/s13037-016-0116-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature. CASE PRESENTATION One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the "cock-robin" position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment. CONCLUSION The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the range of head and neck motion, proper intraoperative positioning and monitoring of the position, and postoperative follow-up. Postoperative atlantoaxial rotatory fixation is not completely preventable, but good perioperative management can minimize the damage resulting from this condition.
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Affiliation(s)
- Hiroshi Sakaida
- Department of Otorhinolaryngology - Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Koji Akeda
- Department of Orthopaedic surgery, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Akihiro Sudo
- Department of Orthopaedic surgery, Mie University Graduate School of Medicine, Tsu, Mie Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology - Head & Neck Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
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Ismi O, Ozalp H, Hamzaoglu V, Bucioglu H, Vayısoglu Y, Gorur K. Grisel's syndrome accompanying a submandibular abscess. Braz J Otorhinolaryngol 2016; 86:658-661. [PMID: 27595925 PMCID: PMC9422572 DOI: 10.1016/j.bjorl.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/04/2016] [Accepted: 07/30/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey.
| | - Hakan Ozalp
- University of Mersin, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Vural Hamzaoglu
- University of Mersin, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
| | - Helen Bucioglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Yusuf Vayısoglu
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Kemal Gorur
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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Abstract
Torticollis can be due to many different etiologies. Torticollis is not a diagnosis, but a symptom of many conditions. We present a case of persistent torticollis in a child that was misdiagnosed during multiple visits to the pediatrician, otolaryngologist, and 3 different emergency departments. Grisel syndrome must be included in the differential diagnosis of any patient with torticollis after a head and neck infection, upper respiratory infection, or postoperative from head and neck surgery. Early diagnosis allows for appropriate management and can prevent significant morbidity.
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15
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Abstract
Atlantoaxial subluxation is a rare condition and requires a high index of suspicion to diagnose and treat in order to avoid long-term sequelae. Here, we present a case of late presentation of a nontraumatic rotatory subluxation of the atlantoaxial joint or atlantoaxial rotatory subluxation. A 17-year-old girl presented 3 months after the onset of nonspecific upper limb sensory symptoms which eventually settled spontaneously. Initial conservative management by the general practitioner had no effect. Computed tomography scanning revealed a Type 1 dislocation with rotatory fixation and with <3 mm anterior displacement of the atlas. The management of Type 1 subluxations is usually conservative with bed rest, oral nonsteroidal anti-inflammatory drugs, muscle relaxants, reduction (if required) and immobilization with a soft collar. This patient, however, required more invasive management due to the late presentation and slightly greater fixed deformity. As the subluxation could not be reduced with active manipulation, Gardner-Wells tongs with traction were applied. She then progressed to a pinned HALO, cyber neck support and subsequently an aspen collar which was eventually weaned off over a few weeks. The outcome and radiologic alignment at follow-up was satisfactory.
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Affiliation(s)
- Meenalochani Shunmugam
- Department of Neurosurgery, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA 5042, Australia
| | - Santosh Poonnoose
- Department of Neurosurgery, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA 5042, Australia
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16
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Barcelos ACES, Patriota GC, Netto AU. Nontraumatic atlantoaxial rotatory subluxation: grisel syndrome. Case report and literature review. Global Spine J 2014; 4:179-86. [PMID: 25083360 PMCID: PMC4111947 DOI: 10.1055/s-0033-1363936] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/22/2013] [Indexed: 11/07/2022] Open
Abstract
Study Design Case report and literature review. Objective To describe a case of nontraumatic atlantoaxial rotatory subluxation (Grisel syndrome) and to review clinical and radiologic aspects, physiopathology, and treatment of this lesion. There is no well-established protocol in the management of patients without spontaneous reduction. The authors discuss the available strategies to achieve reduction and when to operate on these patients. Methods Case presentation of a 7-year-old patient who presented with torticollis ∼1 week after the onset of an upper airway infection. There was no history of head or neck trauma. Computed tomography demonstrated atlantoaxial rotatory subluxation and a normal atlantodental interval. Results The patient was treated with nonsteroidal anti-inflammatory drugs and antibiotics and by progressively increasing the soft cervical collar height. Clinical reduction of the subluxation occurred after 48 hours. He wore the rigid collar for 6 weeks. At that moment, the patient was completely asymptomatic and follow-up cervical spine radiograph demonstrated an anatomical C1-C2 relation. The patient was instructed to return to daily life activities in a gradual manner. Conclusions Grisel syndrome should be considered in the differential diagnosis of torticollis, especially in children. The management can be planned according to the classification of Fielding and Hawkins. The initial treatment involves medicines, injury reduction, and cervical spine immobilization. Surgical treatment is indicated only in cases of failure of conservative treatment, recurrences of subluxation, and irreducible subluxations.
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Affiliation(s)
- Alécio C. E. S. Barcelos
- Division of Neurocritical Care, Department of Neurosurgery Service, Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa, Paraíba, Brazil
| | - Gustavo C. Patriota
- Division of Neurocritical Care, Department of Neurosurgery Service, Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa, Paraíba, Brazil
| | - Arlindo Ugulino Netto
- Praça Vilagran Cabrita, School of Medicine Nova Esperança, João Pessoa, Paraíba, Brazil
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Microtia Reconstruction and Postsurgical Grisel's Syndrome: A Rare Cause of Torticollis in a Child. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e176. [PMID: 25289369 PMCID: PMC4174248 DOI: 10.1097/gox.0000000000000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/11/2014] [Indexed: 11/24/2022]
Abstract
Summary: Grisel’s syndrome is an unusual but important cause of torticollis which may be encountered in a pediatric plastic surgery practice, where craniofacial and oropharyngeal surgeries are commonly performed. Grisel’s syndrome is characterized by painful torticollis and limited cervical rotation, and the diagnosis is confirmed via radiologic imaging. Initial management of Grisel’s syndrome is with anti-inflammatories and in some cases antibiotics. In unresolving or recurrent cases, more invasive treatments, such as cervical collar, halo, or surgical arthrodesis, may be considered.
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18
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Tweel BC, Elmaraghy C. Velopharyngeal incompetence as a complication of Grisel syndrome. Otolaryngol Head Neck Surg 2013; 149:645-6. [PMID: 23884284 DOI: 10.1177/0194599813496972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Benjamin C Tweel
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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19
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Pilge H, Holzapfel BM, Lampe R, Pilge S, Prodinger PM. A novel technique to treat Grisel's syndrome: results of a simplified, therapeutical algorithm. INTERNATIONAL ORTHOPAEDICS 2013; 37:1307-13. [PMID: 23657673 DOI: 10.1007/s00264-013-1895-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Grisel's syndrome is a rare entity and usually develops in paediatric patients after otolaryngologic surgery or infection. It is defined as a fixed torticollis combined with a rotatory atlanto-axial subluxation. The success rate of physiotherapy is low. Conventional therapy concepts imply stage-related recommendations based on the Fielding classification (type I-IV). This classification was introduced in 1977 to assess the degree of subluxation between atlas (C1) and axis (C2). Thus, instability increases from type I to IV. Higher stages may require surgical intervention. The purpose of this study was to evaluate the value of an alternative, less invasive treatment protocol in Grisel's syndrome. METHODS Irrespective of the underlying Fielding type we treated five children (Fielding type I-III) by manual repositioning under general anaesthesia. Consecutively, the cervical spine was immobilized with a Minerva cast for four to eight weeks. Additional surgical treatment or immobilization in a Halo-Fixateur was not necessary. RESULTS Overall period of treatment was reduced, even in patients with delayed diagnosis. No case of recurrence was observed within a follow-up of six months. CONCLUSIONS Current conventional recommendations suggest invasive treatment with Halo-Fixateur in patients with higher degrees of subluxation (e.g., Fielding type III) or after delayed diagnosis. Even in those patients, this novel therapy concept enables us to achieve excellent clinical results without surgical intervention.
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Affiliation(s)
- Hakan Pilge
- Department of Orthopedics and Sports Medicine, Technische Universität München, Munich, Germany.
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Coca-Pelaz A, Vivanco-Allende A, Meilán-Martínez Á, Gómez-Martínez JR. Grisel's Syndrome as a Sequela of a Complicated Acute Mastoiditis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Grisel’s syndrome: a comprehensive review with focus on pathogenesis, natural history, and current treatment options. Childs Nerv Syst 2012; 28:821-5. [PMID: 22293953 DOI: 10.1007/s00381-012-1706-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
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22
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Coca-Pelaz A, Vivanco-Allende A, Meilán-Martínez Á, Gómez-Martínez JR. Grisel's syndrome as a sequela of a complicated acute mastoiditis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:161-4. [PMID: 22264911 DOI: 10.1016/j.otorri.2011.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/08/2011] [Accepted: 11/10/2011] [Indexed: 11/16/2022]
Abstract
Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess.
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Affiliation(s)
- Andrés Coca-Pelaz
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
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CEKINMEZ M, TUFAN K, SEN O, CANER H. Non-traumatic Atlanto-axial Subluxation: Grisel's Syndrome -Two Case Reports-. Neurol Med Chir (Tokyo) 2009; 49:172-4. [DOI: 10.2176/nmc.49.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Melih CEKINMEZ
- Department of Neurosurgery, Baskent University Faculty of Medicine
| | - Kadir TUFAN
- Department of Neurosurgery, Baskent University Faculty of Medicine
| | - Orhan SEN
- Department of Neurosurgery, Baskent University Faculty of Medicine
| | - Hakan CANER
- Department of Neurosurgery, Baskent University Faculty of Medicine
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Karkos PD, Benton J, Leong SC, Mushi E, Sivaji N, Assimakopoulos DA. Grisel's syndrome in otolaryngology: a systematic review. Int J Pediatr Otorhinolaryngol 2007; 71:1823-7. [PMID: 17706297 DOI: 10.1016/j.ijporl.2007.07.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/05/2007] [Accepted: 07/06/2007] [Indexed: 10/23/2022]
Abstract
AIMS to assess etiology, treatment and outcome of Grisel's syndrome. METHODS A Medline search was performed using the terms Grisel's syndrome, spontaneous atlantoaxial subluxation, head, neck, ear, nose and throat. A systematic review of the literature was performed. Case series of both adult and pediatric cases were included. Only papers focusing on true non-traumatic atlantoaxial subluxation were included. RESULTS Seventy-one papers have been published from 1950 to 2006. Forty-eight of these fulfilled our inclusion criteria, totaling 103 patients for review. The main causes of Grisel's syndrome were infection (48%) and post-adenotonsillectomy (31%). Less common causes included other postoperative cases such as pharyngoplasty and ear operations. Neurosurgical consultation was paramount in all cases. In the majority of cases conservative management in the form of bedrest, antibiotics, muscle relaxants, traction and collar was effective; in a few cases only surgery in the form of arthrodesis was deemed necessary. Morbidity was significant in those cases where diagnosis was delayed, with the most devastating consequence a permanent neurological deficit in one case. CONCLUSIONS Grisel's syndrome is a rare but dangerous complication that can go unnoticed in its early phase and can be a major cause of morbidity and mortality following infection or head and neck procedures/interventions. Early recognition of any cervical complication following routine otolaryngological operations together with early neurosurgical consultation is mandatory to prevent devastating consequences.
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Affiliation(s)
- P D Karkos
- Department of Otolaryngology, Liverpool University Hospitals, Liverpool, UK.
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Richter GT, Bower CM. Cervical complications following routine tonsillectomy and adenoidectomy. Curr Opin Otolaryngol Head Neck Surg 2006; 14:375-80. [PMID: 17099343 DOI: 10.1097/01.moo.0000247525.56076.54] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Fortunately, patients undergoing adenotonsillectomies have far more complaints than complications. Sore throats, dysphagia, and neck pain are frequent and expected symptoms after surgery. Differentiating these symptoms from early signs of severe cervical complications can be difficult. Such complications are rare but include atlanto-axial subluxation (Grisel's syndrome), cervical necrotizing fasciitis, cervical emphysema and cervical oseteomyelitis. Due to the frequency with which adenotonsillectomies are performed, most otolaryngologists will encounter these events during their career. This article is thereby intended to elucidate the early warnings, appropriate diagnostic workup, and therapeutic modalities for cervical complications following adenotonsillectomies. RECENT FINDINGS Early recognition and intervention can prevent devastating morbidity and mortality described with cervical complications. Computed tomography scanning remains the gold standard for diagnosing cervical complications after adenotonsillectomy. Although a range of severity exists in cervical complications, most cases can be managed conservatively with broad spectrum antibiotics, observation, bedrest and immobilization in cases of Grisel's syndrome. Cervical necrotizing fasciitis requires a high index of suspicion and urgent management to avoid fatal consequences. SUMMARY This is a review of the most frequently encountered, although rare, cervical complications following adenotonsillectomies. It gives the reader an insight into the efficient diagnosis and management of these complications.
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Affiliation(s)
- Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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