title: Torticollis following tympanoplasty: an index case with lessons in encountering the unexpected.
abstract: The term torticollis is derived from the Latin words 'tortis' for twisted and 'collum' for neck. Typical features include sudden onset of severe unilateral pain, with restriction of movements and deviation of the neck to that side. Although torticollis is a well recognised abnormality, there is minimal literature identifying it as a sole long-standing complication in otological surgery. We present the case of a 15-year-old boy who developed permanent torticollis following a routine tympanoplasty. A CT of the neck revealed an atlantoaxial rotatory fixation with cross fusion between C1 and C2. This case highlights a rare cause of torticollis resulting from a routine otological procedure. It also differentiates between Grisel's syndrome, which is characterised by atlantoaxial subluxation as opposed to fusion. The role of the multidisciplinary team is imperative and in particular the need for urgent discussion with the neurosurgical team to ensure prompt assessment and management of the patient takes place.
authors.affiliation: Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, London, UK.
authors.forename: Krishan
authors.initials: K
authors.lastname: Ramdoo
authors.forename: Andy
authors.initials: A
authors.lastname: Hall
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Dimitriadis
authors.forename: Arvind
authors.initials: A
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000002:abnormalities* / Q000473:pathology; D002574:Cervical Vertebrae / Q000002:abnormalities*; D000013:Congenital Abnormalities / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009334:Neck Muscles; D013035:Spasm / Q000209:etiology*; D013124:Spinal Injuries / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000209:etiology* / Q000473:pathology; D014433:Tympanoplasty / Q000009:adverse effects*