Non-traumatic atlanto-axial dislocation associated with nasopharyngeal infections (Grisel's disease)

Atlantoaxial Rotatory Fixation

“…1), so called because the chin is turned toward 1 side and the neck is laterally flexed to the opposite side, reminiscent of a robin listening for worms. Several predisposing factors have been identified, including upper respiratory infections, [4][5][6][7][8][9][10][11][12][13][14] trauma, 4,10,15-17 and surgery 9,10,[17][18][19] of the head and neck. Additionally, as many as 24% of AARF cases can occur without an obvious predisposing cause.…”

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

“…On physical examination, a rotational deformity is evident, as is loss of cervical mobility. Other signs can include neck tenderness and a positive Sudeck's sign, in which the posterior spinous process of the axis is dis- placed ipsilateral to the torticollis [3,7]. Typically, the neurological examination is normal.…”

“…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]. This leads to spasm of the deep cervical muscles and increased laxity of the atlantoaxial ligaments [1,3]. These two mechanisms in concert are thought to bring about the rotational deformity.…”

“…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.…”

“…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].…”