Turkish Neurosurgery 2011 , Vol 21 , Num 4
The Importance of Early Diagnosis and Appropriate Treatment in Grisel's Syndrome: Report of Two Cases
Ahmet DAGTEKIN1, Engin KARA2, Yusuf VAYISOGLU3, Aslihan KOSEOGLU1, Emel AVCI1, Derya TALAS3, Celal BAGDATOGLU1
1Mersin University, Faculty of Medicine, Department of Neurosurgery, Mersin, Turkey
2Mersin University, Faculty of Medicine, Department of Radiology, Mersin, Turkey
3Mersin University, Faculty of Medicine, Department of Otorhınolaryngology, Mersin, Turkey
DOI : 10.5137/1019-5149.JTN .3120-10.1 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. Keywords : Grisel's syndrome, Non-traumatic atlanto-axial subluxation, Torticollis, Computerized tomography
Corresponding author : Ahmet Dagtekın, dagtekin69@yahoo.com