Grisel Syndrome

Abstract

Grisel syndrome is the subluxation of atlantoaxial joint as a result of infectious or inflammatory processes of the head and neck region. The etiopathogenesis of this clinical entity is not clear yet. Early interventions (antibiotherapy, cervical traction, and immobilization) are critical to avoid catastrophic outcome. Early detection of pediatric atlantoaxial subluxation is essential. It requires a combination of clinical assessment and appropriate radiographic imaging. In this report, we present a clinical and radiologic follow-up of a Grisel syndrome; by this way, we discuss the role of radiology on the diagnosis of this rare entity and preview the relevant literature.

Grisel’s Syndrome: A Rare Complication following Adenotonsillectomy

“…Periodontoid plexus is connected with posterior nasopharyngeal veins via pharyngovertebral vein. Any infective embolism may spread from superior pharyngeal area to upper cervical joints due to this plexus which has not any lymph node [5, 6]. Primary stabilizer is transverse; secondary stabilizer is alar ligament for atlantoaxial joint [5].…”

“…Any infective embolism may spread from superior pharyngeal area to upper cervical joints due to this plexus which has not any lymph node [5, 6]. Primary stabilizer is transverse; secondary stabilizer is alar ligament for atlantoaxial joint [5]. Inflammatory mediators cause synovial and vascular congestion, periligamentous inflammation, and oedema, resulting in subluxation and finally, may progress to imbalance of cervical spine with complicated neurological outcomes [2, 5].…”

“…In 1930, the French physician Grisel who gave his name to the syndrome reported 2 cases having this syndrome which had developed after nasopharyngeal inflammation [2–4]. Increased flexibility of the atlantoaxial joint ligaments has been implicated as the underlying reason for this syndrome [1–3, 5]. Although the etiopathogenesis of this syndrome has not been exactly proven, pediatric age group, history of pharyngitis, adenotonsillitis, abscess of peritonsillar and cervical region, otitis media, trauma, any upper respiratory tract infection, genetic disorders, and to-be-performed head and neck surgery were reported as risk factors.…”

“…There is not a definite consensus criterion for the diagnosis and treatment, but early diagnosis is very important for prognosis. Late diagnosis and inadequate treatment may cause neurological sequelae and/or painful and lasting deformity of the neck [2, 5]. Acute form can be easily treated with bed rest, antibiotics, anti-inflammatory agents, immobilization, and/or simple traction; some acute cases and almost all of the chronic cases (last longer than a month) cannot be conservatively treated.…”

“…Acute form can be easily treated with bed rest, antibiotics, anti-inflammatory agents, immobilization, and/or simple traction; some acute cases and almost all of the chronic cases (last longer than a month) cannot be conservatively treated. The treatment of these patients may also require surgical intervention that may include skeletal traction or bone fusion [5]. In this paper, a case of an eight-year-old male patient who had Grisel's syndrome after adenotonsillectomy is discussed with review of the literature.…”