title: Rotary atlanto-axial subluxation with torticollis following central-venous catheter insertion.
abstract: Atlanto-axial subluxation with torticollis is an uncommon condition that occurs in children usually as a result of pharyngeal infection, minor trauma, or neck surgery. Passive motion of the head and neck during general anesthesia is probably another etiologic factor. Torticollis is the most common presenting physical finding. Pain may or may not be present, but is commonly present with passive neck motion. Neurologic sequelae are uncommon. Our case illustrates this condition as a complication of central venous catheter (CVC) insertion in a child under general anesthesia. The surgeon should suspect this pathology when a child presents with torticollis following CVC placement. Precautions should be taken in the operating room to avoid aggressive rotation and extension of the child's neck while under general anesthesia whether or not cervical inflammation is present. Special attention to head and neck positioning should be taken in patients with Down's syndrome since they are at increased risk for atlanto-axial subluxation. The prognosis is excellent when diagnosed early. A delay in diagnosis can result in the need for surgical intervention.
authors.affiliation: The Floating Hospital for Children, New England Medical Center, Boston, MA 02111, USA.
authors.forename: P
authors.initials: P
authors.lastname: Brisson
authors.forename: H
authors.initials: H
authors.lastname: Patel
authors.forename: R
authors.initials: R
authors.lastname: Scorpio
authors.forename: N
authors.initials: N
authors.lastname: Feins
mesh_terms: D000768:Anesthesia, General; D001268:Atlanto-Axial Joint / Q000293:injuries*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D005134:Eye Neoplasms / Q000601:surgery; D005260:Female; D005910:Glioma / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D026741:Physical Therapy Modalities; D011187:Posture; D011379:Prognosis; D016059:Range of Motion, Articular; D012399:Rotation; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy