Grisel’s Syndrome: A Rare Complication following Adenotonsillectomy

Grisel’s syndrome is a nontraumatic atlantoaxial subluxation which is usually secondary of an infection or an inflammation at the head and neck region. It can be observed after surgery of head and neck region. Etiopathogenesis has not been clearly described yet, but increased looseness of paraspinal ligament is thought to be responsible. Patients typically present with painful torticollis. Diagnosis of Grisel’s syndrome is largely based on suspicion of the patient who has recently underwent surgery or history of infection in head and neck region. Physical examination and imaging techniques assist in diagnosis. Therefore, clinicians should be aware of acute nontraumatic torticollis after recently applied the head and neck surgery or undergone upper respiratory tract infection. In this paper, a case of an eight-year-old male patient who had Grisel’s syndrome after adenotonsillectomy is discussed with review of the literature. 1. Introduction Grisel’s syndrome that is known as the subluxation of atlas and axis was firstly described by Sir Charles Bell in 1830 in a syphilitic patient with pharyngeal ulceration. Bell reported death in this patient by spinal cord compression due to atlanto-axial subluxation and autopsy report showed the erosion of the axis transverse ligament [1–3]. In 1930, the French physician Grisel who gave his name to the syndrome reported 2 cases having this syndrome which had developed after nasopharyngeal inflammation [2–4]. Increased flexibility of the atlantoaxial joint ligaments has been implicated as the underlying reason for this syndrome [1–3, 5]. Although the etiopathogenesis of this syndrome has not been exactly proven, pediatric age group, history of pharyngitis, adenotonsillitis, abscess of peritonsillar and cervical region, otitis media, trauma, any upper respiratory tract infection, genetic disorders, and to-be-performed head and neck surgery were reported as risk factors. There is not a definite consensus criterion for the diagnosis and treatment, but early diagnosis is very important for prognosis. Late diagnosis and inadequate treatment may cause neurological sequelae and/or painful and lasting deformity of the neck [2, 5]. Acute form can be easily treated with bed rest, antibiotics, anti-inflammatory agents, immobilization, and/or simple traction; some acute cases and almost all of the chronic cases (last longer than a month) cannot be conservatively treated. The treatment of these patients may also require surgical intervention that may include skeletal traction or bone fusion [5]. In this paper, a case of an