Grisel's Syndrome in an Adult After Endoscopic Nasopharyngectomy

Abstract

Background Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto‐axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy. Methods A 67‐year‐old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X‐rays of the cervical spine demonstrated atlanto‐axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital‐C1 joint. Results The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post‐op on a cervical collar with minimal pain and no neurologic deficits. Conclusion A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis. Level of Evidence 4

Conservative approach for treatment of Grisel's syndrome after resection of lympahadenitis tuberculosis of the neck: A rare case report

“…Spontaneous subluxation of the atlanto-axial joint following peri-pharyngeal inflammation is known as Grisel's syndrome [9] . This syndrome has been linked to rhinopharyngitis, rheumatic diseases, cervical osteomyelitis, and surgical operations such as adenoidectomy, tonsillectomy, and mastoidectomy [4] , [10] . Distension and abnormal laxity of the ligaments surrounding the atlanto-axial articulation are due to direct spread of inflammation from pharynx and nasopharynx which may result in cervical spine instability with risk of devastating neurological sequelae.…”

Magnetic Resonance Imaging as the Primary Imaging Modality in Children Presenting with Inflammatory Nontraumatic Atlantoaxial Rotatory Subluxation

“…4/7 studies used fat saturation in post contrast imaging. Details on included reports are shown in Table S1 [ 5 , 7 , 15 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Síndrome de Grisel relato de caso e revisão de literatura: follow up de 7 anos de evolução com tratamento incruento

“…A síndrome de Grisel (SG) foi descrita pela primeira vez por Sir Charles Bell em 1830, mas só ganhou seu nome homônimo depois que uma série de dois pacientes foi descrita por Pierre Grisel em 1930 6 . É uma condição rara caracterizada por subluxação rotatória não traumática da articulação atlantoaxial, causada por inflamação prévia ao redor da cabeça e pescoço 11 .…”

“…Acredita-se que a infecção se espalhe da orofaringe e nasofaringe para os ligamentos atlanto-axiais por via hematogênica, por meio de veias faringovertebrais que perfuram a fáscia pré-vertebral e drenam para os plexos ao redor do odontóide. A resposta inflamatória leva então à hiperemia dos ligamentos e cápsulas articulares, causando uma frouxidão patológica que permite a rotação anormal do atlas sobre o eixo 6 . Deve-se suspeitar de SG em pacientes com torcicolo doloroso e febre, amplitude de movimento restrita e dor na tentativa de redução, na ausência de trauma, mas com história de infecções de vias aéreas superiores ou de cabeça e pescoço ou cirurgia otorrinolaringológica 16 .…”