Monopolar electrocautery in adenoidectomy as a possible risk factor for Grisel's syndrome.
OBJECTIVE
Grisel syndrome is a nontraumatic atlantoaxial subluxation after an inflammatory process in the upper cervical region. It results from a peripharyngeal infection as well as a rare complication following adenotonsillectomy. After the introduction of monopolar suction electrocautery in adenoidectomy, an increased incidence of Grisel's syndrome has been observed. The purpose of the study was to evaluate monopolar suction electrocautery as a possible risk factor.


METHODS
Retrospective chart review along with current measurements of monopolar and bipolar electrocautery during adenoidectomy.


METHODS
The charts of 1431 consecutive cases of adenoidectomy were reviewed before (n = 710) and after (n = 721) the introduction of monopolar suction electrocautery for intraoperative hemostasis. Moreover, energy of delivered current of electrocautery was measured in 30 pediatric patients during adenoidectomy.


RESULTS
Three cases of Grisel's syndrome occurred as a postoperative complication in 721 adenoidectomies (0.4%) after the introduction of monopolar suction electrocautery. In contrast, no Grisel's syndrome was observed in 710 procedures before the use of monopolar electrocautery. Current measurements demonstrate an almost fourfold higher level of electrical energy using monopolar electrocautery compared with bipolar coagulation for bleeding control in adenoidectomy.


CONCLUSIONS
Monopolar suction cautery in adenoidectomy may be considered as a risk factor for Grisel's syndrome.
Tschopp
Kurt
K
Department of Otorhinolaryngology, Kantonsspital Liestal, Liestal, Switzerland. kurt.tschopp@ksli.ch
D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods*; D001268:Atlanto-Axial Joint; D002648:Child; D004564:Electrocoagulation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome