title: Grisel's syndrome: a rare complication of tonsillectomy.
abstract: OBJECTIVE
  To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.
  
  
  METHODS
  We report a case of post-tonsillectomy atlanto-axial subluxation, also known as Grisel's syndrome, in a child. On the third day after surgery, the boy presented with torticollis with no neurological deficit. Rotatory atlanto-axial subluxation was clearly shown in computed tomography scans of the neck. Cervical traction for one week successfully reduced the subluxation, with no long-term sequelae.
  
  
  CONCLUSIONS
  Pre-existing cervical ligamentous laxity and post-operative infection are believed to be the main causes of Grisel's syndrome. Although it is rare, patients are advised to seek treatment early if any neck pain or fever persists. Early diagnosis is important for better treatment outcome. Initial conservative measures are advised before more invasive cervical traction is adopted.
authors.affiliation: ORL Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. kj_sia@yahoo.com
authors.forename: K J
authors.initials: KJ
authors.lastname: Sia
authors.forename: I P
authors.initials: IP
authors.lastname: Tang
authors.forename: C K L
authors.initials: CK
authors.lastname: Kong
authors.forename: A
authors.initials: A
authors.lastname: Nasriah
mesh_terms: D001268:Atlanto-Axial Joint; D002648:Child; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D009989:Orthotic Devices; D011183:Postoperative Complications / Q000175:diagnosis; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014068:Tonsillectomy / Q000009:adverse effects*; D014103:Torticollis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D014143:Traction