title: [Grisel's syndrome following ENT-surgery: report of two cases].
abstract: BACKGROUND
  Non-traumatic atlanto-axial subluxation is a rare complication of upper neck inflammatory processes and head and neck surgery. It is called Grisel's syndrome named after P. Grisel, who first described this condition in 1930. Persistent torticollis following head and neck surgery or upper respiratory tract infections should alert the surgeon to a beginning atlanto-axial subluxation. Due to lax ligaments it especially occurs in children and patients with Down's syndrome.
  
  
  METHODS
  We present two cases of Grisel's syndrome in children following head and neck surgery with prolonged history, discussing pathogenesis, diagnostic measures and therapy.
  
  
  CONCLUSIONS
  Although there are several theories concerning the actual pathogenesis, it is generally agreed that an inflammatory process is the primary cause of Grisel's syndrome. Therefore, early antibiotic treatment is recommended. Further treatment depends on clinical findings and Fielding classification of the degree of the subluxation and includes muscle relaxations, soft collar or stiff neck, cervical traction or even arthrodesis of C1 and C2. If recognised early and appropriate treatment is applied, the prognosis is excellent. Severe cases can present with degenerative disorders of the cervical spine or even with neurological malfunction.
authors.affiliation: Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Hannover Nordstadt und HNO-Klinik, Kinderkrankenhaus "Auf der Bult", Hannover, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hirth
authors.forename: H-J
authors.initials: HJ
authors.lastname: Welkoborsky
mesh_terms: D001268:Atlanto-Axial Joint; D001915:Braces; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D037981:Neck Dissection; D011183:Postoperative Complications; D011379:Prognosis; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy; D014103:Torticollis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy