Spontaneous pneumarthrosis of the atlantoaxial joint

Abstract

<jats:p>The authors describe the case of a 29-year-old man presenting with left retrooccipital and cervical pain associated with left ear fullness and rhythmic tinnitus. Head rotation movements on the right side and the Valsalva maneuver increased symptoms. A CT scan identified hyperpneumatization of the left temporal bone extending to the occipital bone as well as pneumarthrosis of the atlantoaxial joint. Surgical treatment involving obliteration of the fistula with bone and fat grafts via a computer-aided transmastoid approach was proposed. The surgery resolved all of the patient's symptoms except for the ear fullness. In this case the authors described an original treatment for spontaneous atlantoaxial pneumarthrosis. Long-term follow-up is needed to evaluate the risk of the recurrence of abnormal occipital bone pneumatization and to assess joint function.</jats:p>

Hyperpneumatisation of the craniocervical bones: an emerging aetiological pattern

“…Treatment reported by other authors has ranged from advising against performing the Valsalva manoeuvre, 6 through steroid nasal spays, 5 to myringotomy and grommet insertion, 3,4 and in one case surgical exploration and obliteration of airspaces using bone and fat grafts. 7 As our case demonstrates, addressing the cause of raised middle-ear pressure may result in both a rapid improvement in symptoms and a reversal of the pathological process.…”

“…There are very few other cases in the literature of skull base hyperpneumatisation involving the upper cervical vertebrae; however, all have in common a history of raised middle-ear pressure, minor trauma or both. [3][4][5][6][7][8] The most intriguing aspect of this condition is the fact that the pneumatisation process is able to cross seemingly intact synchondroses and joints. Both Turowski et al 4 and Littrell et al 5 Whilst the former authors proposed a mechanism of micro-fractures caused by pressure changes in the mastoid air cells, the latter supported the eustachian tube ball-valve theory, and suggested that persistently raised middle-ear pressure could lead to an erosive process of bony destruction capable of crossing the temporo-occipital synchrondosis and atlanto-occipital joints.…”

Craniocervical Pneumatization

“…Pediatric case reports would be expected in the setting of a congenital anomaly and, in contrast, the youngest reported patients with CCP have been clustered in their 20s and 30s (1,(9)(10)(11)14,16,19,20). Limited histopathologic data on aberrantly pneumatized bone did not describe a mucosal …”

“…Although there could be a genetic predisposition, CCP is an acquired process that can progress with time (5,18,19) and improve when treated (1,2,4,5,7,11,19,21). Pediatric case reports would be expected in the setting of a congenital anomaly and, in contrast, the youngest reported patients with CCP have been clustered in their 20s and 30s (1,(9)(10)(11)14,16,19,20).…”

“…In addition to previous reports showing short-term efficacy (7,11,19,21), we have shown that PE tubes can provide a durable result for at least 5 years, though it is important to note that PE tubes are a temporizing measure and not a cure. For patients who fail PE tubes or present with acute clinical deterioration secondary to pneumocranium, the intention of mastoidectomy would be to permanently obliterate the communication between the mastoid cavity and aberrantly pneumatized bone (1,18).…”