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Grisel's syndrome: a rare complication of tonsillectomy

Published online by Cambridge University Press:  24 February 2012

K J Sia ,
I P Tang ,
C K L Kong  and
A Nasriah
K J Sia*
Affiliation:
ORL Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
I P Tang
Affiliation:
ORL Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
C K L Kong
Affiliation:
Department of Diagnostic Imaging, Sibu Hospital, Sarawak, Malaysia
A Nasriah
Affiliation:
Department of Diagnostic Imaging, Sibu Hospital, Sarawak, Malaysia
*
Address for correspondence: Dr Kian Joo Sia, 14A, Lorong 4A, Jalan Pipit, 96000 Sibu, Sarawak, Malaysia Fax: +60 82419495 E-mail: [email protected]
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Abstract

Objectives:

To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.

Case report:

We report a case of post-tonsillectomy atlanto-axial subluxation, also known as Grisel's syndrome, in a child. On the third day after surgery, the boy presented with torticollis with no neurological deficit. Rotatory atlanto-axial subluxation was clearly shown in computed tomography scans of the neck. Cervical traction for one week successfully reduced the subluxation, with no long-term sequelae.

Conclusion:

Pre-existing cervical ligamentous laxity and post-operative infection are believed to be the main causes of Grisel's syndrome. Although it is rare, patients are advised to seek treatment early if any neck pain or fever persists. Early diagnosis is important for better treatment outcome. Initial conservative measures are advised before more invasive cervical traction is adopted.

Keywords

Grisel's SyndromeAtlanto-Axial SubluxationComplication, PostoperativeTonsillectomyTorticollis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 529 - 531
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Grisel, P. Enucleation of the atlas and nasopharyngeal torticollis [in French]. La Presse Med 1930;38:50–3Google Scholar
2Battiata, AP, Pazos, G. Grisel's syndrome: the two hits hypothesis. Ear Nose Throat J 2004;83:553–5CrossRefGoogle Scholar
3Fielding, JW, Hawkins, RJ. Atlanto-axial rotatory fixation. J Bone Joint Surg Am 1977;59:37–44CrossRefGoogle ScholarPubMed
4Wilson, BC, Jarvis, BL, Haydon, RC 3rd.Nontraumatic subluxation of the atlantoaxial joint: Grisel's syndrome. Ann Otol Rhinol Laryngol 1987;96:705–8Google ScholarPubMed
5Karkos, PD, Benton, J, Leong, S, Mushi, E, Sivaji, N, Assimakopoulos, D. Grisel's syndrome in otolaryngology: a systemic review. Int J Pediatric Otorhinolaryngol 2007;71:1823–7Google Scholar
6Parke, WW, Rothman, RH, Brown, MD. The pharyngovertebral veins: an anatomical rationale for Grisel's syndrome. J Bone Joint Surg 1984;66:568–74CrossRefGoogle ScholarPubMed
7Bell, C. The Nervous System of the Human Body, Embracing the Papers Delivered to the Royal Society on the Subject of the Nerves. London: Longmans, 1830;403Google Scholar
8Jackson, H. The diagnosis of minimal atlanto-axial subluxation. Brit J Radiol 1950;23:672–4CrossRefGoogle ScholarPubMed
9Lakeisha, RH, Thomas, JG, Eric, AM. Does increased electrocautery during adenoidectomy lead to neck pain? Otolaryngol Head Neck Surg 2005;133:556–61Google Scholar
10Harma, A, Firat, Y. Grisel syndrome: nontraumatic atlantoaxial rotatory subluxation. J Craniofac Surg 2008;19:1119–21CrossRefGoogle ScholarPubMed
11Byeoknyeon, K, Keiko, I, Kenji, S, Shogo, S, Yoshiaki, E, Hironaka, T et al. Significance of prevention and early treatment of a postoperative twisted neck: atlantoaxial rotatory subluxation after head and neck surgery. J Anesth 2010;24:598–602Google Scholar
12Martinez-Lage, JF, Morales, T, Fernandez Cornejo, V. Atlanto-axial rotatory subluxation in children: early management. Acta Neurochir 2001;143:1223–8CrossRefGoogle ScholarPubMed
13Deichmueller, CMC, Welkoborsky, HJ. Grisel's syndrome – a rare complication following “small” operations and infections in the ENT region. Eur Arch Otorhinolaryngol 2010;267:1467–73CrossRefGoogle ScholarPubMed