Nontraumatic Subluxation of the Atlantoaxial Joint: Grisel's Syndrome

Abstract

Grisel's syndrome is defined as subluxation of the atlantoaxial joint not associated with trauma or bone disease. Primarily an affliction of children, the disorder may occur in association with any condition that results in hyperemia and pathologic relaxation of the transverse ligament of the atlantoaxial joint, including several common otolaryngic entities. Grisel's syndrome has been noted infrequently in the otolaryngologic literature; this paper reports a case from West Virginia University Hospital of a 6-year-old boy with radiographic evidence of retropharyngeal cellulitis following meningitis progressing to atlantoaxial subluxation. Discussed are the pathophysiologic aspects of Grisel's syndrome with an anatomic explanation recently described to account for the syndrome.

A novel technique to treat Grisel’s syndrome: results of a simplified, therapeutical algorithm

“…Usually children under the age of 12 are affected, without any gender-specific predisposition [1,2]. Manifestation in adults is exceptionally rare [3].…”

Grisel’s syndrome: A Rare Non-traumatic Subluxation of Atlanto-axial Joint

“…Although any head and neck surgery can predispose to Grisel`s syndrome but most common surgeries are mastoidectomy, tonsillectomy and adenoidectomy respectively. Infections of the upper respiratory tract and bony pathologies involving cervical spine should also be considered in the differential diagnosis [5]. In our case the condition was secondary to adenotonsillectomy.…”

Midcervical Postinfectious Ligamentous Instability: A Variant of Grisel’s Syndrome

“…Grisel's syndrome has been described as a rotational deformity involving the atlantoaxial joint that occurs after an upper respiratory infection [1][2][3][4][6][7][8]. This condition occurs most commonly in children.…”

“…Typically, the neurological examination is normal. The management of this syndrome consists of cervical traction to reduce the deformity, followed by rigid cervical immobilization and treatment of the infectious process [6,8]. The proposed pathophysiology is spread of the pharyngeal inflammatory process to the surrounding muscles as well as the ligament complexes supporting the atlantoaxial articulation [5].…”

“…Upper respiratory infections have been a well-documented predisposing factor for atlantoaxial rotatory fixation, and this entity has become known as Grisel's syndrome [1][2][3][4][5][6][7][8]. The pathophysiology of this disorder is thought to be spread of the inflammatory process through venous and lymphatic channels connecting the pharyngeal and prevertebral spaces [5].…”