Significance of prevention and early treatment of a postoperative twisted neck: atlantoaxial rotatory subluxation after head and neck surgery

Kim, Byeoknyeon; Iwata, Kazuya; Sugimoto, Kenji; Suzuki, Satoshi; Ema, Yoshiaki; Tsunobuchi, Hironaka; Nishiwaki, Kimitoshi

doi:10.1007/s00540-010-0932-3

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…The usual presentation of AARS is with cervical pain, head tilt, and restricted and painful neck mobility. The patient's neck is laterally flexed, and the chin is rotated to the opposite side, which is known as the cock-robin deformity (3,11). Sudeck's sign, palpating spinous process of the axis in the contralateral side, also may be found in severe AARS.…”

Section: Discussionmentioning

confidence: 97%

Atlantoaxial Rotary Subluxation After Tympanoplasty

Kim¹,

Choi²,

Choi³

et al. 2011

Otology &Amp; Neurotology

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Section: Discussionmentioning

confidence: 97%

Atlantoaxial Rotary Subluxation After Tympanoplasty

Kim¹,

Choi²,

Choi³

et al. 2011

Otology &Amp; Neurotology

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“…Children undergoing otologic surgery under general anesthesia are at higher risk of AARF. In 2010, Kim et al proposed the first guidelines for perioperative care of patients with a risk of AARF [ 8 ]. We are basically in agreement with the proposal [ 8 ], but we would like to add some practical measures to prevent AARF from the perspective of otologic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…In 2010, Kim et al proposed the first guidelines for perioperative care of patients with a risk of AARF [ 8 ]. We are basically in agreement with the proposal [ 8 ], but we would like to add some practical measures to prevent AARF from the perspective of otologic surgeons. First, informed consent should include the possibility of postoperative AARF, although it is a rare occurrence.…”

Section: Discussionmentioning

confidence: 99%

Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children

et al. 2017

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BackgroundAtlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature.Case presentationOne patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the “cock-robin” position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment.ConclusionThe correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the range of head and neck motion, proper intraoperative positioning and monitoring of the position, and postoperative follow-up. Postoperative atlantoaxial rotatory fixation is not completely preventable, but good perioperative management can minimize the damage resulting from this condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s13037-016-0116-7) contains supplementary material, which is available to authorized users.

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“…Both anesthesiologist and surgeon must check the mobility of the patient's neck prior to operation. Kim et al [ 13 ] proposed a set of guidelines for prevention of AARF. These guidelines consist of the following elements: (1) informed consent, (2) preoperative check, (3) appropriate surgical position, and (4) postoperative check.…”

Section: Discussionmentioning

confidence: 99%

Case Report of Atlantoaxial Rotatory Fixation after Cochlear Implantation

Nakashima

Matsuda

Okuda

et al. 2016

Case Reports in Otolaryngology

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Atlantoaxial rotatory fixation (AARF) is a relatively rare condition and is mainly seen in children. We report of a 7-year-old girl suffering from AARF after cochlear implantation (CI). Fortunately, early diagnosis based on three-dimensional computed tomography (3DCT) was made, and the patient was cured with conservative therapy. Nontraumatic AARF, which is also known as Grisel's syndrome and occurs subsequent to neck infections or ear, nose, and throat (ENT) surgery, represents only a small fraction of AARF cases. Two factors are mainly thought to contribute to the pathogenesis of the condition estimated, namely, (i) neck immaturity in children and (ii) infiltration by inflammatory mediators around the upper neck joint, easily permitted by the neck vasculature. AARF should be suspected in case of torticollis developing after ENT surgery.

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Significance of prevention and early treatment of a postoperative twisted neck: atlantoaxial rotatory subluxation after head and neck surgery

Cited by 16 publications

References 20 publications

Atlantoaxial Rotary Subluxation After Tympanoplasty

Atlantoaxial Rotary Subluxation After Tympanoplasty

Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children

Case Report of Atlantoaxial Rotatory Fixation after Cochlear Implantation

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