title: Grisel's syndrome--a rare complication following "small" operations and infections in the ENT region.
abstract: The atlanto-axial subluxation (Grisel's syndrome) is a rare complication following operative procedures and/or infections in the upper aerodigestive tract. Pathogenetically the higher flexibility of the ligaments during the inflammation causes a subluxation between axis and atlas. When the inflammation heals, this can probably result in a fixation in the rotated position. The purpose of the present study was to describe the clinical and radiological characteristics of this rare disease in children. The clinical files of 12 patients with Grisel's syndrome were examined retrospectively. The clinical files of these patients were reviewed and analyzed along with the results of radiographic and laboratory examinations. The clinical parameters were compared with the patient's therapy and outcome. Of 12 children (6 males, 6 females, average age of 7.1 years), Grisel's syndrome developed following surgery in 8 patients, and in another 4 patients following a severe in infection of the upper aerodigestive tract. The duration of complaints differed from 2 days to 6 months. All patients had a torticollis as the first symptom of atlanto-axial dislocation and three children had accompanying cervical lymphadenopathy. All patients were given antiphlogistic therapy either with diclofenac or ibuprofen. Additionally, 11 patients were treated with intravenous antibiotics (amoxicillin, ampicillin, clindamycin or cephalosporins) and 1 child with oral antibiotics. In eight patients a remission during antibiotic therapy occurred. In four cases (2 with Grisel's syndrome following surgery, 2 following infection), however, the torticollis persisted despite adequate conservative treatment and required reposition of the atlanto-axial joint along with external fixation. In all of them, starting of therapy was delayed. An early diagnosis of Grisel's syndrome and immediate therapy is most important. Grisel's syndrome must be taken under consideration in children with acute torticollis following either an infection or operative procedure in the upper aerodigestive tract. Early adequate antibiotic and antiphlogistic therapy is mandatory and leads to a high remission rate.
authors.affiliation: Dept. of Otorhinolaryngology, Children's Hospital auf der Bult, Hannover, Germany. cordula.deichmueller@krh.eu
authors.forename: C M C
authors.initials: CM
authors.lastname: Deichmueller
authors.forename: H-J
authors.initials: HJ
authors.lastname: Welkoborsky
mesh_terms: D000233:Adenoidectomy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001268:Atlanto-Axial Joint; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D016267:External Fixators; D005260:Female; D005759:Gastroenteritis / Q000150:complications*; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D037981:Neck Dissection; D019152:Paracentesis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D013577:Syndrome; D014069:Tonsillitis / Q000150:complications*; D014103:Torticollis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014433:Tympanoplasty
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal
references.citation: J Laryngol Otol. 2007 Aug;121(8):800-2
references.pmid: 17295941
references.citation: J Laryngol Otol. 1995 Oct;109(10):1005-9
references.pmid: 7499935
references.citation: Orthop Clin North Am. 1978 Oct;9(4):955-67
references.pmid: 740386
references.citation: J Bone Joint Surg Am. 1984 Apr;66(4):568-74
references.pmid: 6707036
references.citation: Am J Otolaryngol. 2002 Jan-Feb;23(1):60-5
references.pmid: 11791252
references.citation: Spine (Phila Pa 1976). 2005 Aug 1;30(15):E444-9
references.pmid: 16094264
references.citation: Clin Orthop Relat Res. 1989 Jul;(244):131-46
references.pmid: 2663284
references.citation: J Bone Joint Surg Am. 1977 Jan;59(1):37-44
references.pmid: 833172
references.citation: Unfallchirurg. 2002 Jun;105(6):565-8
references.pmid: 12132197
references.citation: Laryngorhinootologie. 2003 Nov;82(11):799-804
references.pmid: 14634899
references.citation: Int J Pediatr Otorhinolaryngol. 2007 Dec;71(12):1823-7
references.pmid: 17706297
references.citation: J Laryngol Otol. 2001 Aug;115(8):669-72
references.pmid: 11535156
references.citation: Can J Neurol Sci. 2009 Jan;36(1):109-13
references.pmid: 19294901
references.citation: Laryngorhinootologie. 2003 Nov;82(11):794-8
references.pmid: 14634898