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Grisel's syndrome: a rare complication of tonsillectomy

Published online by Cambridge University Press:  24 February 2012

K J Sia ,
I P Tang ,
C K L Kong  and
A Nasriah
K J Sia*
Affiliation:
ORL Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
I P Tang
Affiliation:
ORL Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
C K L Kong
Affiliation:
Department of Diagnostic Imaging, Sibu Hospital, Sarawak, Malaysia
A Nasriah
Affiliation:
Department of Diagnostic Imaging, Sibu Hospital, Sarawak, Malaysia
*
Address for correspondence: Dr Kian Joo Sia, 14A, Lorong 4A, Jalan Pipit, 96000 Sibu, Sarawak, Malaysia Fax: +60 82419495 E-mail: kj_sia@yahoo.com
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Abstract

Objectives:

To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.

Case report:

We report a case of post-tonsillectomy atlanto-axial subluxation, also known as Grisel's syndrome, in a child. On the third day after surgery, the boy presented with torticollis with no neurological deficit. Rotatory atlanto-axial subluxation was clearly shown in computed tomography scans of the neck. Cervical traction for one week successfully reduced the subluxation, with no long-term sequelae.

Conclusion:

Pre-existing cervical ligamentous laxity and post-operative infection are believed to be the main causes of Grisel's syndrome. Although it is rare, patients are advised to seek treatment early if any neck pain or fever persists. Early diagnosis is important for better treatment outcome. Initial conservative measures are advised before more invasive cervical traction is adopted.

Keywords

Grisel's SyndromeAtlanto-Axial SubluxationComplication, PostoperativeTonsillectomyTorticollis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 529 - 531
Copyright
Copyright © JLO (1984) Limited 2012

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