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Atlanto-axial rotatory fixation: a serious potential complication of paediatric ENT surgery that requires prompt diagnosis and treatment

Published online by Cambridge University Press:  25 September 2017

G James  and
D N P Thompson
G James*
Affiliation:
Department of Neurosurgery, Great Ormond Street Hospital for Children, London, and Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
D N P Thompson
Affiliation:
Department of Neurosurgery, Great Ormond Street Hospital for Children, London, and Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
*
Address for correspondence: Mr Greg James, Department of Neurosurgery, Great Ormond Street Hospital for Children, London WC1N 3JH, UK Fax: +44 (0)20 7813 8244 E-mail: gregory.james@gosh.nhs.uk
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Abstract

Background:

Atlanto-axial rotatory fixation is a persistent deformity of the C1–2 vertebral relationship caused by subluxation of the articular surfaces, and can occur after positioning for ENT procedures where the head is rotated – for example to access the ear or posterior triangle of the neck. If promptly recognised, it can usually be managed successfully with conservative methods, without long-lasting sequelae, but delayed or inappropriate management may lead to permanent neck deformity, neurological problems and pain.

Method:

Case review.

Case report:

Two children with atlanto-axial rotatory fixation following ENT surgery; one child was referred early and managed successfully, and one had delayed referral resulting in permanent severe positional deformity.

Conclusion:

Atlanto-axial rotatory fixation is easily missed; there are significant clinical and medicolegal implications if it is not promptly recognised. A suggested management algorithm is presented.

Keywords

Atlanto-Axial JointTorticollisOtorhinolaryngologic Surgical ProceduresIatrogenic Disease
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 11 , November 2017 , pp. 940 - 945
Copyright
Copyright © JLO (1984) Limited 2017 

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