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Baptista de Lima J, Barros B, Mota Pinheiro I, Souto JP, Cerqueira Silva M, Pires Borges J, Machado L, Pereira J, Cunha J. Cervical Pain in a Seventeen-year-old Girl. Pediatr Infect Dis J 2024; 43:606-608. [PMID: 38753995 DOI: 10.1097/inf.0000000000004303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Joana Baptista de Lima
- From the Pediatrics Department, Centro Materno-Infantil do Norte (CMIN) do Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
| | - Bárbara Barros
- Pediatrics Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Isabel Mota Pinheiro
- Pediatrics Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - José Paulo Souto
- Orthopedics and Traumatology Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Marta Cerqueira Silva
- Orthopedics and Traumatology Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Joana Pires Borges
- Pediatrics Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Leonilde Machado
- Pediatrics Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Joana Pereira
- Orthopedics and Traumatology Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
| | - Joaquim Cunha
- Pediatrics Department, Centro Hospitalar Tâmega e Sousa (CHTS), Penafiel, Portugal
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Morimoto LR, Kase DT, Esmanhotto PG, Maciel MA, Augusto ACL, Catricala PF, Anaya JEC, Mukherjee S, Fernandes ARC, Aihara AY. Imaging Assessment of Nontraumatic Pathologic Conditions at the Craniovertebral Junction: A Comprehensive Review. Radiographics 2024; 44:e230137. [PMID: 38635454 DOI: 10.1148/rg.230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Nontraumatic pathologic conditions of the craniovertebral junction encompass a range of conditions affecting the complex anatomy of this region without direct physical injury. These conditions include congenital syndromes that predispose individuals to ligamentous laxity, potentially leading to instability. Additionally, rare but noteworthy cases such as Grisel syndrome, a cause of pediatric torticollis, may arise without a traumatic trigger. Inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and crystal deposition, can lead to cervical instability and spinal cord compression. Infections at the upper cervical spine are dominated by tuberculosis, typically transmitted through hematologic or lymphatic routes with characteristic imaging findings. On the other hand, purulent bacterial infections in this area are rare. Furthermore, although tumors involving the structures of the craniovertebral junction are infrequent, they can lead to significant complications, albeit less frequently through cord compression and more commonly via pathologic fractures or subluxation. The craniocervical junction is a complex anatomic region comprising ligaments, bones, joints, and muscles that support the head's weight and enable its wide range of motion. Accurate recognition and understanding of the complex anatomy and the various nontraumatic pathologic conditions at the craniovertebral junction are pivotal for initiating timely and appropriate treatment strategies. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Letícia R Morimoto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Paola G Esmanhotto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Murilo A Maciel
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Ana C L Augusto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Patrick F Catricala
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Julia E C Anaya
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Sugoto Mukherjee
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
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Al-Hussain OH, Al-Hussain G. Diagnostic Approach and Treatment Options for Pediatric Cases of Grisel's Syndrome Post Otolaryngology Procedure: A Systematic Review. Cureus 2024; 16:e51739. [PMID: 38187032 PMCID: PMC10771032 DOI: 10.7759/cureus.51739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/09/2024] Open
Abstract
Grisel's syndrome is an uncommon cervical spine condition marked by non-traumatic rotational subluxation of the atlantoaxial joint. This systematic review aims to collect potential evidence from relevant studies that reported symptoms, diagnostic methods, and management options among pediatric cases of Grisel's syndrome post otolaryngology procedures, which can aid and guide the diagnosis and management in clinical practice. We conducted both electronic and manual search strategies within the potential databases and included case reports, case series, and articles; however, review papers and correspondence papers were excluded. The post-otolaryngology procedures included adenoidectomy, tonsillectomy, tympanoplasty, cochlear implantation, double opposing Z plasty and pharyngeal flap, and adenotonsillectomy. In this systematic review, we identified and analyzed 20 studies encompassing a total of 24 pediatric patients with Grisel's syndrome following otolaryngology procedures. The patient demographics revealed a fairly even distribution between females (45.83%) and males (50.00%), with ages ranging from 2.5 to 12 years. The most common otolaryngology procedures associated with Grisel's syndrome were adenoidectomy (29.17%) and adenotonsillectomy (33.33%). Clinical symptoms included neck pain (75.00%), torticollis (50.00%), and limited neck mobility (20.83%), while diagnostic confirmation primarily relied on CT scans (50.00%). Treatment strategies varied, with conservative measures being the most frequent choice, followed by surgical interventions in four cases (16.67%). Complications were reported in 20.83% of cases. Due to the rarity of this condition, our findings are limited to case reports only, which may limit the generalizability of results. Grisel syndrome can be effectively managed through conservative treatment, including antibiotics and anti-inflammatory drugs if diagnosed timely. Early diagnosis and prompt management are essential to avoid neurological and fatal complications. This analysis would contribute to improving clinical knowledge and treatment strategies while providing additional insights into this rare condition.
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Affiliation(s)
- Omair H Al-Hussain
- Otolaryngology - Head and Neck Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Cunha NSC, Malvea A, Sadat S, Ibrahim GM, Fehlings MG. Pediatric Spinal Cord Injury: A Review. Children (Basel) 2023; 10:1456. [PMID: 37761417 PMCID: PMC10530251 DOI: 10.3390/children10091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life.
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Affiliation(s)
| | - Anahita Malvea
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
| | - Sarah Sadat
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - George M. Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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Hong WJ, Lee JK, Hong JH, Han MS, Lee SS. Iatrogenic atlantoaxial rotatory subluxation after thyroidectomy in a pediatric patient: A case report. World J Clin Cases 2023; 11:3351-3355. [PMID: 37274043 PMCID: PMC10237141 DOI: 10.12998/wjcc.v11.i14.3351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is an uncommon disease with a greater prevalence among children than adults, and it is mostly associated with trauma. Iatrogenic spinal injury accounts for a low percentage of injuries. However, in AARS, 20%-40% of cases are associated with surgery, and 48% are caused by infection. Here, we describe our experience with a case of iatrogenic AARS after general anesthesia.
CASE SUMMARY A 12-year-old girl presented with right-sided torticollis and cervical motion limit. The patient had undergone thyroidectomy 2 mo ago. Computed tomography revealed AARS with bilateral locked facets. Following the failure of repeated external reduction under general anesthesia, the patient underwent an open surgical reduction. The patient gained atlantoaxial alignment without any complications. Follow-up radiographs showed a normal appearance without instability. The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences. AARS secondary to infection and surgery is known as Grisel’s syndrome, which involves non-traumatic AARS. Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported. Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor.
CONCLUSION Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery. Moreover, clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.
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Affiliation(s)
- Woo-Joon Hong
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Jong-Hwan Hong
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju 61469, South Korea
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Alkhaldi A, Alwadi F, Alenezi M, Alshammari J. Hyaluronic acid augmentation pharyngoplasty complicated by retropharyngeal abscess and grisel syndrome: Case report and literature review. Clin Case Rep 2022; 10:e05901. [PMID: 35600025 PMCID: PMC9122795 DOI: 10.1002/ccr3.5901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/23/2022] [Accepted: 05/01/2022] [Indexed: 11/10/2022] Open
Abstract
Augmentation pharyngoplasty, in which tissue filler or grafts are used to augment the posterior nasopharynx, is an accepted option to treat velopharyngeal insufficiency. It is generally well tolerated and safe with limited side effects. In this study, we describe a case of a retropharyngeal abscess and Grisel syndrome following hyaluronic acid augmentation pharyngoplasty. Grisel syndrome is a serious condition that requires early diagnosis and prompt intervention to prevent further complications. Velopharyngeal insufficiency (VPI) can be treated conservatively by speech therapy or surgically by augmentation pharyngoplasty and pharyngeal surgeries. Augmentation pharyngoplasty is safe and well‐tolerated procedure. We report a very rare complication of this procedure which is retropharyngeal abscess and Grisel syndrome (GS). GS is a serious condition that requires early diagnosis and prompt intervention to prevent further neurological complications.
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Affiliation(s)
- Abdullah Alkhaldi
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Fahad Alwadi
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
| | - Mazyad Alenezi
- Department of Otolaryngology Head and Neck Surgery College of Medicine Qassim University Qassim Saudi Arabia
| | - Jaber Alshammari
- Otolaryngology Head & Neck Surgery King Abdullah Specialized Children Hospital King Abdulaziz Medical City National Guard Health Affairs Riyadh Saudi Arabia.,King Abdullah International Medical Research Center Riyadh Saudi Arabia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Takada G, Asato H, Umekawa K, Kurabayashi T, Sasaki S, Kaji N. Atlantoaxial Rotatory Fixation after Microtia Reconstruction Surgery. Plast Reconstr Surg Glob Open 2021; 9:e3760. [PMID: 34476155 DOI: 10.1097/GOX.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Bem Junior LS, do Rêgo Aquino PL, Filho JRMC, Rabelo NN, de Azevedo Filho HRC. Nontraumatic subluxation of the atlanto-axial joint: Case report and brief review. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.101086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mülkoğlu C, Genç H, Vural S, Mansız-Kaplan B. Unusual presentation of an unusual disease: A very delayed diagnosis of Grisel's syndrome. Turk J Phys Med Rehabil 2021; 67:259-63. [PMID: 34396079 DOI: 10.5606/tftrd.2021.4967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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White MD, Hansberry DR, Prabhu AV, Agarwal N, Kandula V. Grisel’s syndrome: A rare cause of torticollis with subluxation of the atlantoaxial joint secondary to a retropharyngeal abscess. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pini N, Ceccoli M, Bergonzini P, Iughetti L. Grisel's Syndrome in Children: Two Case Reports and Systematic Review of the Literature. Case Rep Pediatr 2020; 2020:8819758. [PMID: 33274097 DOI: 10.1155/2020/8819758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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. J Craniovertebr Junction 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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Reddy KN, Baig SM, Batra M, Colodner K, Madubuko U, Korban A, Pandya Shah S. Grisel's syndrome: a case report on this rare pediatric disease and its anesthetic challenges. BMC Anesthesiol 2020; 20:255. [PMID: 32998694 PMCID: PMC7526423 DOI: 10.1186/s12871-020-01176-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background Grisel’s syndrome is a non-traumatic atlantoaxial subluxation associated with inflammatory conditions of the head and neck, which occurs primarily in children. Increased flexibility of the ligaments during inflammation is implicated in the pathogenesis of the subluxation between the axis and atlas. The potential sequelae may be severe, and early diagnosis and treatment of Grisel’s syndrome can prevent tragic outcomes. Case presentation We present a case of torticollis in an 8-year-old child. She had a two-week history of a streptococcal throat infection. The patient was treated with several different methods of conservative care, including muscle relaxation, cervical halter traction, and Halo application. However, the torticollis persisted. The patient then required surgical correction involving cervical spine fusion. She had no complications and experienced no reoccurrence of the torticollis to date. Conclusion Grisel’s syndrome is a pathology for which conservative management is successful in most cases. Cases requiring surgical intervention are rarely documented in the literature. Our case is significant, as in spite of aggressive conservative management, the patient required surgical correction. Patients requiring surgical management of Grisel’s syndrome may require additional anesthetic exposure for diagnostic interventions like magnetic resonance imaging or neck manipulations for closed reduction. We discuss the features of Grisel’s syndrome and specific anesthetic management considerations for procedures such as magnetic resonance imaging, application of cervical traction, and surgical correction of torticollis.
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Affiliation(s)
| | - Shabaaz M Baig
- Department of Anesthesiology, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB-E 577, Newark, NJ, 07103, USA
| | - Meenu Batra
- Department of Anesthesiology, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB-E 577, Newark, NJ, 07103, USA
| | | | | | - Anna Korban
- Department of Anesthesiology, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB-E 577, Newark, NJ, 07103, USA
| | - Shridevi Pandya Shah
- Department of Anesthesiology, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB-E 577, Newark, NJ, 07103, USA.
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Abstract
While pediatric cervical spine injuries (CSI) are rare, they are associated with high morbidity and mortality and sometimes require expeditious surgical management. In this article, we aim to improve the diagnostic accuracy of pediatric CSI by reviewing normal pediatric cervical anatomy, typical pediatric CSI patterns, and common mimics of pediatric CSI. A literature review was conducted on pediatric CSI, its epidemiology, and the various imaging manifestations and mimics. The most common pediatric CSI occur in the upper cervical spine owing to the higher fulcrum and larger head at a young age, namely prior to age 9 years, while lower CSI occur more frequently in patients older than 9 years. While various craniocervical measurements may be utilized to identify craniocervical disruption, soft tissue injuries may be the only manifestation, thus making pediatric CSI difficult to diagnose on initial imaging. In the acute setting, CT cervical spine is an appropriate initial imaging modality for pediatric CSI evaluation. MRI serves as an additional tool to exclude or identify injuries when initial findings are equivocal. It is essential to recognize the unique anatomy and biomechanics of the pediatric spine and thus discern common pediatric CSI patterns and their mimics.
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Affiliation(s)
- Mindy X Wang
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, Houston, TX, USA.
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.
| | - Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, Memorial Hermann, Houston, TX, USA
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA
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Affiliation(s)
- Jin-A Park
- Resident, Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Hee Jun Yi
- Resident, Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Ju Wan Kang
- Associate Professor, Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju, South Korea
| | - Jeong Hong Kim
- Professor, Department of Otorhinolaryngology, Jeju National University School of Medicine, Jeju 63243, South Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tam I, Lee B, Stover LB. More Than a Pain in the Neck: An Unusual Case of Persistent Neck Stiffness in a 10-Month-Old. Clin Pediatr (Phila) 2019; 58:1371-1373. [PMID: 31257913 DOI: 10.1177/0009922819859865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivy Tam
- Children's Hospital at Montefiore, Bronx, NY, USA
| | - Begem Lee
- University of California-San Diego, Rady Children's Hospital, San Diego, CA, USA
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Chua AJK, Tan BWS, Tan TY, Heah HHW. Grisel's Syndrome in an Adult After Endoscopic Nasopharyngectomy. Laryngoscope Investig Otolaryngol 2019; 4:504-507. [PMID: 31637293 PMCID: PMC6793604 DOI: 10.1002/lio2.298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto‐axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy. Methods A 67‐year‐old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X‐rays of the cervical spine demonstrated atlanto‐axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital‐C1 joint. Results The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post‐op on a cervical collar with minimal pain and no neurologic deficits. Conclusion A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis. Level of Evidence 4
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Affiliation(s)
- Andy J. K. Chua
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
| | - Bernard W. S. Tan
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
| | - Tiong Yong Tan
- Department of RadiologyChangi General HospitalSingaporeSingapore
| | - Harold H. W. Heah
- Department of OtolaryngologySingapore General HospitalSingaporeSingapore
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Affiliation(s)
- Philippa Anna Stilwell
- General Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Debra Fine
- GPVTS, University College London Hospitals NHS Foundation Trust, London, UK
| | - James Roberts
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leanne Goh
- General Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Anania P, Pavone P, Pacetti M, Truffelli M, Pavanello M, Ravegnani M, Consales A, Cama A, Piatelli G. Grisel Syndrome in Pediatric Age: A Single-Center Italian Experience and Review of the Literature. World Neurosurg 2019; 125:374-382. [PMID: 30797917 DOI: 10.1016/j.wneu.2019.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nontraumatic atlantoaxial subluxation, also known as Grisel syndrome, is a rare disease that usually affects children. The typical presentation is torticollis in patients with a history of surgical operations or airway infections. METHODS We describe 5 patients with Grisel syndrome, referring to medical care for a torticollis, a few weeks after an airway infection, with no trauma associated. Radiologic confirmation of the diagnosis, with computed tomography and magnetic resonance imaging studies, was carried out. RESULTS The patients were treated with external immobilization for 3 months, followed by surgical fixation in the case of recurrence after collar removal or inveterate subluxation. We performed a review of the literature to define the best management of this disease. CONCLUSIONS Management of Grisel syndrome depends on the degree of subluxation basing on the Fielding and Hawkins classification. The initial nonsurgical management consists of close reduction and immobilization. Surgical fixation is indicated in cases of conservative treatment failure.
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Affiliation(s)
- Pasquale Anania
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy.
| | - Piero Pavone
- Department of Pediatrics, University Hospital B Policlinico-Vittorio Emanuele, Catania, Italy; Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Mattia Pacetti
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Monica Truffelli
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy; Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marco Pavanello
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marcello Ravegnani
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Alessandro Consales
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Armando Cama
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Gianluca Piatelli
- Neurosurgery, Pediatric Hospital Giannina Gaslini, University of Genoa, Genoa, Italy
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Abstract
Introduction Grisel syndrome is a non-traumatic rotary subluxation of C1 on C2 (atlantoaxial subluxation). It is a rare condition predominantly described in paediatric population with previous history of upper respiratory infections orotolaryngeal procedures. The diagnosis is established by the association of clinical and radiologic findings4,6. We report a case of 15-year old boy with Grisel syndrome accompanying multifocal sepsis (pericarditis, septic polyarthritis, pneumonia and pharangytis ), treated surgically - occipital cervical fusion using struts of iliac crest tri-cortical graft wired to the occiput and C3 and C4. Objective To describe a case of non-traumatic atlantoaxial rotatory subluxation (Grisel syndrome) and to review clinical and radiologic aspects, pathophysiology, and treatment of this rare condition, which if left untreated can lead to catastrophic outcomes. Authors are trying to demonstrate the significance of early intervention for improved outcomes, and that physicians should examine patients with multifocal sepsis thoroughly so as not to miss foci of infection and have high index of suspicion of the syndrome in patients that present with neck swelling, and develop torticollis and neurological deficit. Methods This is a case presentation of a 15-year-old boy who presented with an acute history of neck swelling, shortness of breath, orthopnoea, pericardial effusion, right hip and knee swelling. He later developed torticollis and left sided hemiplegia. On admission, he was septicemic. There was no history of head or neck trauma. Cervical spine radiograph showed increased atlantodental index (ADI) and prevertebral soft tissue swelling. Consent was sought from guardian and patient to use images and case notes for submission for publication. Results The patient was treated with analgesia, drainage of pericardial effusion and intravenous antibiotics. The right knee sepsis was noted on admission and drained on the day pericardial drain was inserted, while the right hip was missed - only to be noted 59 days later with limb length discrepancy. The C1/C2 subluxation was noted 17 days after admission. Reduction was done soon after diagnosis and maintained with a halo-thoracic immobilizer. A week later, he underwent posterior occipital cervical fusion. The hemiplegia resolved fully. Conclusions Multifocal staphylococcal septicemia can present with unusual foci of infection, which may be missed especially if the patient is very sick. Grisel syndrome with an associated left hemiplegia and septic arthritis of the right hip were diagnosed late in this case. Grisel syndrome patients might end up with catastrophic outcomes if left untreated or mis-diagnosed, but if prompt treatment is initiated, full functional recovery is achievable.
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Affiliation(s)
- Vincent L Mkochi
- Assistant lecturer and Postgraduate Trainee in Trauma and Orthopaedics, College of Medicine, University of Malawi
| | - Nyengo Mkandawire
- Consultant Trauma and Orthopaedic Surgeon; Dean of Faculty of Medicine, College of Medicine, University of Malawi
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Ozalp H, Hamzaoglu V, Avci E, Karatas D, Ismi O, Talas DU, Bagdatoglu C, Dagtekin A. Early diagnosis of Grisel's syndrome in children with favorable outcome. Childs Nerv Syst 2019; 35:113-8. [PMID: 30361761 DOI: 10.1007/s00381-018-3996-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The painful torticollis only itself may be a major sign for the diagnosis of Grisel's syndrome (GS). It is known as an inflammatory atlantoaxial rotatory subluxation following upper respiratory tract infections (URTI) and surgical otolaryngological procedures. PATIENTS AND METHODS The analysis of 16 pediatric GS patients were reviewed retrospectively by considering the diagnosis, the treatment modality, and the prognosis at the Department of Neurosurgery and Otorhinolaryngology in Mersin University, Faculty of Medicine between 2008 and 2018. In addition to the clinical cases, five cadavers were used to demonstrate atlantoaxial region, particularly the ligamentous complex and articulation of the atlas-axis, for the mechanism of these rare entities. RESULTS The most common etiological factor of GS was URTI with 81.25% among 16 patients. Painful torticollis was the primary symptom of pediatric patients at admission. The X-Ray, computerized tomography (CT), and magnetic resonance imaging (MRI) investigations were used for the definitive diagnosis in the first week of admission, except one. No morbidity, mortality, and deformity were reported in this series. CONCLUSIONS Early diagnosis is the principle of GS for avoiding of permanent neck deformity and complex surgical procedures. If GS can be diagnosed without any doubt by only considering patient's history and clinical examination, CT scan is not recommended due to harmful effects of radiation. The treatment was achieved by reduction, external fixation under analgesia, or sedoanalgesia accompanying with antibiotic and anti-phylogistic treatment.
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Lee HY, Chen CL, Chiu CH. An atlantoaxial rotatory subluxation secondary to a parapharyngeal abscess. Pediatr Neonatol 2018; 59:423-424. [PMID: 29366675 DOI: 10.1016/j.pedneo.2018.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/06/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hao-Yuan Lee
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; Molecular Infectious Disease Research Center, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Fath L, Cebula H, Santin MN, Coca A, Debry C, Proust F. The Grisel's syndrome: A non-traumatic subluxation of the atlantoaxial joint. Neurochirurgie 2018; 64:327-330. [PMID: 29731316 DOI: 10.1016/j.neuchi.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Grisel's syndrome consists in rotational subluxation of C1-C2 following ENT infection or surgery. There is no consensus on management. We present 2 cases requiring surgical treatment in our center. CASE REPORTS Two 10-year-old patients presented torticollis with cervical pain resistant to medical treatment, with onset a few months after tonsillectomy. In both cases, radiological assessment, comprising CT scan and MRI, showed Fielding-Hawkins type-3 C1-C2 rotational subluxation, without ligament lesion. After failure of conservative treatment, posterior reaming, realignment, C1-C2 arthrodesis using lateral masses and pars interarticularis screws and bone graft achieved good fusion and immediate spinal stability in all planes of the atlantoaxial complex. DISCUSSION Grisel's syndrome consists in non-traumatic subluxation of the atlantoaxial joint with intact atlantoaxial ligaments. Initial pharyngeal inflammation spreads to the prevertebral fascia via direct connections between the periodontoidal venous plexus and pharyngovertebral veins, inducing fasciitis that leads to abnormal relaxation of the atlantoaxial ligaments and reactional muscle contraction with ankylosis. This phenomenon, appearing gradually and insidiously over a period of a few weeks, creates a frozen joint with ankylosis. Medical treatment with NSAIDs, muscle relaxants, and immobilization is usually sufficient; cervical traction may be needed. Surgical treatment by C1-C2 arthrodesis is indicated in case of failure of medical management or onset of neurologic signs. CONCLUSION Close collaboration between pediatricians, ENT surgeons and neurosurgeons is essential for early diagnosis and management, which is the main prognostic factor for successful medical treatment, avoiding surgery.
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Affiliation(s)
- L Fath
- CHU de Strasbourg, hôpital de Hautepierre, service d'ORL et chirurgie cervico-faciale, 67200 Strasbourg, France.
| | - H Cebula
- CHU de Strasbourg, hôpital de Hautepierre, service de neurochirurgie, 67200 Strasbourg, France
| | - M N Santin
- CHU de Strasbourg, hôpital de Hautepierre, service de neurochirurgie, 67200 Strasbourg, France
| | - A Coca
- CHU de Strasbourg, hôpital de Hautepierre, service de neurochirurgie, 67200 Strasbourg, France
| | - C Debry
- CHU de Strasbourg, hôpital de Hautepierre, service d'ORL et chirurgie cervico-faciale, 67200 Strasbourg, France
| | - F Proust
- CHU de Strasbourg, hôpital de Hautepierre, service de neurochirurgie, 67200 Strasbourg, France
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Miller BJ, Lakhani R, Rashid A, Tostevin P. Painful torticollis following adenotonsillectomy: a cardinal sign of atlantoaxial subluxation. BMJ Case Rep 2018; 2018:bcr-2017-223567. [PMID: 29496687 DOI: 10.1136/bcr-2017-223567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An 11-year-old boy with a history of autism spectrum disorder attended the emergency department with his mother 8 days after an adenotonsillectomy reporting postoperative bleeding. Detailed physical examination revealed no active bleeding, but a rigid neck posture was noted. A head and neck CT scan demonstrated unilateral rotatory atlantoaxial subluxation and possible damage to the anterior spinal ligament. He was reviewed by neurosurgeons who performed manipulation under anaesthetic and successfully realigned the occipital cervical tract. Non-traumatic atlantoaxial subluxation (Grisel's syndrome) is a rare but serious complication of routine ear, nose and throat (ENT) procedures. An awareness of this complication among paediatricians, otolaryngologists and emergency physicians, and a high index of suspicion in any patient presenting with torticollis following ENT surgery is essential in preventing significant neurological morbidity.
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Affiliation(s)
| | - Raj Lakhani
- Department of Otolaryngology, St George's Hospital, London, UK
| | - Arif Rashid
- Oral and Maxillofacial Surgery, The Royal Marsden Hospital, Sutton, UK
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Ahn AR, Park YH, Park EJ, Yim SY. A Case of Grisel Syndrome Showing No Underlying Laxity of the Atlanto-axial Joint. Ann Rehabil Med 2017; 41:511-515. [PMID: 28758092 PMCID: PMC5532360 DOI: 10.5535/arm.2017.41.3.511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/24/2016] [Indexed: 11/17/2022] Open
Abstract
Grisel syndrome is a rare, non-traumatic atlanto-axial subluxation associated with an inflammatory or infectious process in the upper neck. According to the two-hit hypothesis, which is widely accepted for the pathogenesis of Grisel syndrome, preexisting ligamentous laxity of the atlanto-axial joint is regarded as the first hit. An inflammatory or infectious process of the atlanto-axial joint acts as the second hit, resulting in non-traumatic atlanto-axial subluxation. We report on a 6-year-old girl with atlanto-axial subluxation following retropharyngeal and cervical lymphadenitis. She was diagnosed with Grisel syndrome, for which an initial computed tomography did not show any preexisting ligamentous laxity of the atlanto-axial joint. A literature review found only 4 case reports on Grisel syndrome with an initially normal atlanto-axial joint. The present case offers some evidence that a single hit, such as inflammatory changes in the atlanto-axial joint, might cause Grisel syndrome, even without underlying ligamentous laxity.
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Affiliation(s)
- Ah-Reum Ahn
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Yul-Hyun Park
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Eun Ji Park
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Young Yim
- The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Das S, Chakraborty S, Das S. Grisel Syndrome in Otolaryngology: A Case Series with Literature Review. Indian J Otolaryngol Head Neck Surg 2016; 71:66-69. [PMID: 31741933 DOI: 10.1007/s12070-016-1030-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022] Open
Abstract
Grisel's syndrome is non traumatic atlanto axial subluxation usually associated with inflammatory conditions of head and neck region. Non traumatic atlanto axial joint subluxation is a rare entity for an unsuspecting otolaryngologist. The condition if missed and not treated properly can have serious implications with possible neurological deficit. We attempt to review the existing literature on the disease condition and also to highlight the proper management of the condition. Retrospective analysis of hospital record of last five years and an internet based literature survey on the current concepts and management of the condition. We have come across five cases of Grisel's syndrome over the last five years. The clinicopathological and radiological features are described. Grisel syndrome may remain undiagnosed at initial presentation if not suspected. Delayed diagnosis may result in life long morbidity for the patient and the need for surgical intervention. Many of the early cases can be treated successfully by conservative approach.
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Affiliation(s)
- Soumyajit Das
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Suvamoy Chakraborty
- 1Department of ENT, Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok, 737102 India
| | - Subhajit Das
- Department of Radiology, Mazumder Shaw Medical Centre, Bommasandra, Bengaluru, Karnataka 560099 India
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Riascos R, Bonfante E, Cotes C, Guirguis M, Hakimelahi R, West C. Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know. Radiographics 2016; 35:2121-34. [PMID: 26562241 DOI: 10.1148/rg.2015150035] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. Understanding the anatomy of the CCJ is crucial in properly evaluating the cervical spine, allowing the radiologist to assess its stability in the trauma setting. The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Thin-section multidetector computed tomography with sagittal and coronal reformats is the study of choice in evaluating the extent of injury, allowing the radiologist to thoroughly evaluate the stability of the cervical spine. Furthermore, magnetic resonance (MR) imaging is increasingly being used to evaluate the spinal soft tissues and ligaments, and to identify associated spinal cord injury, if present. MR imaging is also indicated in patients whose neurologic status cannot be evaluated within 48 hours of injury. .
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Affiliation(s)
- Roy Riascos
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Eliana Bonfante
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Claudia Cotes
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Mary Guirguis
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Reza Hakimelahi
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
| | - Clark West
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.)
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Dodd KW, Weston BW, Marinelli WA, Moore JC. An unusual cause of cardiopulmonary arrest. Intern Emerg Med 2016; 11:833-5. [PMID: 27141847 DOI: 10.1007/s11739-016-1455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Kenneth W Dodd
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA.
- Department of Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
| | - Benjamin W Weston
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA
| | - William A Marinelli
- Department of Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Johanna C Moore
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, 55415, USA
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34
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nakashima T, Matsuda K, Okuda T, Tono T, Takaki M, Hayashi T, Hanamure Y. Case Report of Atlantoaxial Rotatory Fixation after Cochlear Implantation. Case Rep Otolaryngol 2016; 2016:6486271. [PMID: 27340580 DOI: 10.1155/2016/6486271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 04/14/2016] [Indexed: 12/01/2022] Open
Abstract
Atlantoaxial rotatory fixation (AARF) is a relatively rare condition and is mainly seen in children. We report of a 7-year-old girl suffering from AARF after cochlear implantation (CI). Fortunately, early diagnosis based on three-dimensional computed tomography (3DCT) was made, and the patient was cured with conservative therapy. Nontraumatic AARF, which is also known as Grisel's syndrome and occurs subsequent to neck infections or ear, nose, and throat (ENT) surgery, represents only a small fraction of AARF cases. Two factors are mainly thought to contribute to the pathogenesis of the condition estimated, namely, (i) neck immaturity in children and (ii) infiltration by inflammatory mediators around the upper neck joint, easily permitted by the neck vasculature. AARF should be suspected in case of torticollis developing after ENT surgery.
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Allegrini D, Autelitano A, Nocerino E, Fogagnolo P, De Cillà S, Rossetti L. Grisel's syndrome, a rare cause of anomalous head posture in children: a case report. BMC Ophthalmol 2016; 16:21. [PMID: 26931792 PMCID: PMC4774015 DOI: 10.1186/s12886-016-0197-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/23/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Anomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel's syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP. CASE PRESENTATION A case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis. CONCLUSION GS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis.
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Affiliation(s)
- Davide Allegrini
- Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. .,Unit of Ophthalmology, Melegnano Hospital, Vizzolo Predabissi, Milan, Italy.
| | - Alessandro Autelitano
- Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy.
| | | | - Paolo Fogagnolo
- Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy.
| | - Stefano De Cillà
- Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy. .,Unit of Ophthalmology, Maggiore della Carità Hospital, Novara, Italy.
| | - Luca Rossetti
- Eye Clinic, San Paolo Hospital, University of Milan, Via di Rudini' 8, 20142, Milan, Italy.
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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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Martins J, Almeida S, Nunes P, Prata F, Lobo ML, Marques JG. Grisel syndrome, acute otitis media, and temporo-mandibular reactive arthritis: A rare association. Int J Pediatr Otorhinolaryngol 2015; 79:1370-3. [PMID: 26060148 DOI: 10.1016/j.ijporl.2015.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
We present a case report of a four-year-old boy with torcicollis and trismus after acute otitis media. Grisel Syndrome diagnosis in association with temporo-mandibular reactive arthritis was admitted, leading to early conservative treatment. GS should be suspected in a child presenting with torticollis after an upper respiratory tract infection or an ENT surgical procedure. The association with temporo-mandibular reactive findings is somehow rarer but not impossible, due to the close vascular communication between retropharyngeal and pterigoid spaces.
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Abstract
Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process in the upper neck. It is rare to find literary reports of Grisel's syndrome with an evident pathogen in a lesion. For the first time in Korea, we report a 36-year-old female with Grisel's syndrome having an atlantoaxial subluxation, which was caused by a retropharyngeal abscess secondary to pulmonary Mycobacterium tuberculosis. The patient was treated with an anti-tuberculosis regimen and was prescribed a Philadelphia collar for the control of torticollis. The result of magnetic resonance imaging (MRI) showed an improved atlantoaxial alignment, after drug treatment and immobilization. This patient was neurologically intact and free from symptomatic complaints at follow-up visit. Dynamic cervical radiograph confirmed that the atlantoaxial joints had been stable. The pathophysiology of Grisel's syndrome, along with anatomical attributes, was explained on the basis of the patient's clinical course.
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Affiliation(s)
- Jun Ki Lee
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Guro Cham Teun Teun Hospital, Seoul, Korea
| | - Hyung-Chun Park
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
| | - Seung Hwan Yoon
- Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
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Elyajouri A, Assermouh A, Abilkacem R, Agadr A, Mahraoui C. Grisel's syndrome: a rare complication following traditional uvulectomy. Pan Afr Med J 2015; 20:62. [PMID: 26090020 PMCID: PMC4450045 DOI: 10.11604/pamj.2015.20.62.5930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/08/2015] [Indexed: 11/21/2022] Open
Abstract
A case is reported of an eight-month-old female patient who had traditional uvulectomy for sore throat complicated by Grisel's syndrome. She was admitted into the hospital one week after uvulectomy with Torticolis. Grisel's syndrome is a nontraumatic atlantoaxial subluxation, usually secondary of an infection or an inflammation at the head and neck area, or after surgery in the same area. Patients typically suffer from painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently undergone surgery or has a history of an infection in head and neck area. Physical examination and imaging techniques assist in diagnosis. Thus, clinicians should be aware of acute nontraumatic torticollis if patient had a recent surgery in the head or neck area or undergone an upper respiratory tract infection. In this paper, a case of an eight-month-old female patient who had Grisel's syndrome after uvulectomy is discussed. This case is reported to highlight this neurogical threatening complication following traditional uvulectomy as well as highlighting the unnecessary morbidity and mortality associated with this persisting mode of treatment in Africa.
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Affiliation(s)
- Abdelhakim Elyajouri
- Pediatric Unit, Mohammed V Military Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Abdellah Assermouh
- Pneumo-allergology unit of Rabat children hospital, Faculty of Medicine, Mohammed V University Rabat, Morocco
| | - Rachid Abilkacem
- Pediatric Unit, Mohammed V Military Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Aomar Agadr
- Pediatric Unit, Mohammed V Military Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Chafiq Mahraoui
- Pneumo-allergology unit of Rabat children hospital, Faculty of Medicine, Mohammed V University Rabat, Morocco
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Abstract
ABSTRACT
BACKGROUND AND IMPORTANCE:
Acquired atlantoaxial instability of inflammatory origin (Grisel syndrome) is a rare condition. It usually occurs in children with benign upper airway problems and responds well to immobilization, rarely requiring C1-2 arthrodesis. Our recent experience with 2 adult cases suggests this may not be true in an older subpopulation.
CLINICAL PRESENTATION:
A 71-year-old man developed C1-2 instability in the setting of culture-negative endocarditis. Initial immobilization was attempted for 8 weeks but new imaging revealed progressive destruction of the odontoid and worsening instability. Symptoms resolved after C1-4 arthrodesis. A 35-year-old woman developed C1-2 instability after a molar extraction and otitis media. Despite 12 weeks of immobilization and antibiotics, symptoms persisted and the atlantodental interval increased. She was successfully treated with a C1-2 arthrodesis.
CONCLUSION:
A literature review revealed 13 reports (14 cases) of inflammatory atlantoaxial instability in patients aged 18 and older since 1830. Including the 2 cases reported here, 11 cases underwent initial nonoperative treatment with durable satisfactory results in only 2 of them (18.2%). Aspiration of the C1-2 phlegmon was diagnostic in only 4 of these 16 cases. Destruction of the odontoid was seen in a minority of cases (5/16, 31.3%). In this first review of the topic since the introduction of screw-based C1-2 fixation, it is suggested that nonoperative treatment is futile for inflammatory atlantoaxial instability in adults and strong consideration should be given to C1-2 arthrodesis. This procedure can reliably produce good outcomes with minimal morbidity.
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Affiliation(s)
- Mena Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth B. Jeans
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Ricardo B.V. Fontes
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Harel Deutsch
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang JC, Malic C, Reilly C, Verchere C. Microtia Reconstruction and Postsurgical Grisel's Syndrome: A Rare Cause of Torticollis in a Child. Plast Reconstr Surg Glob Open 2014; 2:e176. [PMID: 25289369 DOI: 10.1097/GOX.0000000000000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Lefaucheur R, Derrey S, Fetter D, Wallon D, Gilard V, Maltête D. Non-traumatic cervical C1-C2 subluxation. Joint Bone Spine 2014; 81:545-6. [PMID: 24703623 DOI: 10.1016/j.jbspin.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Romain Lefaucheur
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France.
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hosiptal, University of Rouen, Rouen, France
| | - Damien Fetter
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - David Wallon
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hosiptal, University of Rouen, Rouen, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
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Bucak A, Ulu S, Aycicek A, Kacar E, Miman MC. Grisel's Syndrome: A Rare Complication following Adenotonsillectomy. Case Rep Otolaryngol 2014; 2014:703021. [PMID: 24782937 DOI: 10.1155/2014/703021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/03/2014] [Indexed: 11/19/2022] Open
Abstract
Grisel's syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisel's syndrome after adenotonsillectomy is discussed with review of the literature.
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Affiliation(s)
- Benjamin C Tweel
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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49
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Tauchi R, Imagama S, Ito Z, Ando K, Muramoto A, Matsui H, Matsumoto T, Ukai J, Kobayashi K, Shinjo R, Nakashima H, Ishiguro N. Atlantoaxial rotatory fixation in a child after bilateral otoplastic surgery. Eur J Orthop Surg Traumatol 2013; 24 Suppl 1:S289-92. [PMID: 23754633 DOI: 10.1007/s00590-013-1254-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/29/2013] [Indexed: 11/25/2022]
Abstract
Atlantoaxial rotatory fixation (AARF), which is a dislocation or subluxation of the atlantoaxial joint, is a well-recognized condition in children. We present a case of AARF after otoplastic surgery for bilateral cryptotia performed by plastic surgeons. The pediatric patient presented with neck pain and torticollis after the surgery, and an orthopedic surgeon diagnosed AARF. The patient was treated successfully with conservative treatment incorporating mild manual manipulation, neck traction, and a collar for 1.5 months. Physicians should consider the possibility of AARF when a patient presents with neck pain and torticollis after otoplastic surgery; diagnosis and treatment should be started immediately.
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Affiliation(s)
- Ryoji Tauchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 4668550, Japan
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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. Int Orthop 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] [What about the content of this article? (0)] [Affiliation(s)] [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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