title: Cranial nerve IX and X impairment after a sports-related Jefferson (C1) fracture in a 16-year-old male: a case report.
abstract: BACKGROUND
  Jefferson (C1) fractures are rare cervical spine injuries that usually do not result in cranial nerve (CN) impairment. However, case reports of Collet-Sicard syndrome (impairment of CNs IX-XII) and impairment of CNs IX, X, and XII have been reported. All reported cases involved adult patients in high-impact collisions, such as motor vehicle accidents or falls. To our knowledge, a Jefferson fracture with selective CN impairment due to a low-energy, sports-related injury in a pediatric patient has not been reported.
  
  
  METHODS
  Chart and radiographic data for a single case were reviewed and reported in a retrospective study approved by the Institutional Review Board of the participating hospital.
  
  
  RESULTS
  A 16-year-old male was diagnosed with a Jefferson fracture after a head-to-chest football collision. On computed tomography, the distance between the atlas transverse process and styloid process of the skull was 5 mm right and 10 mm left. Before halo fixation, the patient had vague complaints of dysphagia. These complaints worsened which led to the diagnosis of CN IX and X impairment and placement of a feeding tube. The fracture healed uneventfully, the dysphagia symptoms resolved, and the halo fixation and feeding tube were removed. The patient returned to all activities, but was instructed to avoid participation in contact sports.
  
  
  CONCLUSIONS
  This was the first report of selective CN impairment in a pediatric patient with a Jefferson fracture resulting from a low-impact sports-related injury. Careful monitoring of the patient complaints led to appropriate treatment. Further studies into the spatial relationship between the transverse process of the atlas in relation to the styloid process of the skull may be warranted.
  
  
  METHODS
  Level V, case report.
authors.affiliation: Center for Orthopedics and Sports Medicine, Akron Children's Hospital, Akron, OH 44308, USA.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Dettling
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Morscher
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Masin
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Adamczyk
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications*; D002574:Cervical Vertebrae / Q000293:injuries*; D020435:Glossopharyngeal Nerve Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D016103:Spinal Fractures / Q000150:complications*; D020421:Vagus Nerve Diseases / Q000209:etiology*