title: The importance of early diagnosis and appropriate treatment in Grisel's syndrome: report of two cases.
abstract: Grisel's syndrome designates subluxation of atlanto-axial joint unrelated to     trauma or bone disease. Atlanto-axial subluxation is seen after the upper neck     inflammatory processes of head and neck region. Moreover, this rare clinical     entity has been observed after various otolaryngological surgical approaches     including adenoidectomy, tonsillectomy and mastoidectomy. An 8-year-old girl and     14 year-old boy presented with complaints of painful torticollis. The first     patient was operated on at another health center due to adenoid hypertrophy. She     was referred to our clinic on the postoperative 5th day with painful     torticollis. The diagnosis was established by computerized tomography and     three-dimensional reconstructions. The second patient had a history of throat     infection. Radiological investigation demonstrated atlantoaxial subluxation. The     patients were treated with external fixation, antibiotic therapy, muscle     relaxants, and anti-inflammatory therapy. Early diagnosis and appropriate     treatment resulted in a good outcome in our patients. Grisel's syndrome must be     considered in the differential diagnosis in children with painful torticollis     associated with upper respiratory tract infection and after various     otolaryngological surgical procedures. We report two cases of Grisel's syndrome     which emphasize on the importance of early diagnosis for appropriate and     successful treatment.
authors.affiliation: Mersin University, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey. dagtekin69@yahoo.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dagtekin
authors.forename: Engin
authors.initials: E
authors.lastname: Kara
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Vayisoglu
authors.forename: Aslihan
authors.initials: A
authors.lastname: Koseoglu
authors.forename: Emel
authors.initials: E
authors.lastname: Avci
authors.forename: Derya
authors.initials: D
authors.lastname: Talas
authors.forename: Celal
authors.initials: C
authors.lastname: Bagdatoglu
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D002648:Child; D042241:Early Diagnosis; D016267:External Fixators; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000628:therapy*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D008297:Male; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000628:therapy*