Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2005 Aug;25(4):245-9.

Grisel's syndrome: a rare complication following adenoidectomy

C Bocciolini  1 , D Dall'Olio, E Cunsolo, P P Cavazzuti, P Laudadio
Affiliations
Case Reports

Grisel's syndrome: a rare complication following adenoidectomy

C Bocciolini et al. Acta Otorhinolaryngol Ital. 2005 Aug.

Abstract
in English, Italian

Grisel's syndrome, defined as subluxation of the atlanto-axial joint, not associated with trauma or bone disease, is found primarily in children. There are few references to this syndrome in the ENT literature but it may occur in association with any condition that results in hyperaemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. Several common otolaryngeal conditions have been associated with the syndrome: pharyngitis, adenotonsillitis, tonsillar abscess, cervical abscess, and otitis media. Moreover, the syndrome has been observed after numerous otolaryngologic procedures such as tonsillectomy, adenoidectomy and mastoidectomy. Non-traumatic subluxation of the atlanto-axial joint should be suspected in cases of persistent neck pain and stiffness. X-rays and computed tomography scans of the cervical spine can confirm the diagnosis. Early management, consisting of cervical immobilization and medical treatment, is considered the key factor for a satisfactory outcome. Inappropriate treatment may result in a permanent and painful neck deformity that may even require surgical fusion. Neurological complications have been reported in the literature, with outcome ranging from mild paresthesia, clonus, to quadriplegia or acute respiratory failure and death. The case is described of an 8-year-old boy who developed Grisel's syndrome following adenoidectomy. The pathogenesis, classification, diagnosis, and treatment of this condition are discussed.

La sindrome di Grisel, definita come sublussazione dell’articolazione atlanto-assiale non associata a trauma o malattia delle ossa, è un’affezione principalmente dei bambini. Non osservata frequentemente nella letteratura otorinolaringoiatrica, questa si può verificare in associazione con qualsiasi condizione che induca iperemia e rilassamento patologico del legamento trasverso dell’articolazione atlanto-assiale. Molte entità comuni otorinolaringoiatriche sono state associate alla sindrome: faringite, adenotonsillite, ascesso tonsillare, ascesso cervicale ed otite media. Inoltre la sindrome si può verificare dopo alcune procedure otorinolaringoiatriche come la tonsillectomia, adenoidectomia e mastoidectomia. La sublussazione atlanto-assiale dovrebbe essere sospettata nei casi di dolore persistente al collo e rigidità. Radiografie e tomografie assiali computerizzate della colonna cervicale stabiliscono la diagnosi. Il trattamento precoce, che consiste in una immobilizzazione cervicale e trattamento medico, viene considerato il fattore chiave per ottenere una guarigione adeguata. Casi trattati inappropriatamente possono manifestarsi con una fissità e deformità dolorosa del collo, tali da poter richiedere una riduzione chirurgica. Nella letteratura sono state riportate complicanze neurologiche, con disturbi che variano da una modesta parestesia, a cloni, a tetraplegia fino ad una insufficienza respiratoria acuta e morte. Noi descriviamo un caso di sindrome di Grisel occorso in un bambino sottoposto ad adenoidectomia. In questo articolo vengono discusse la patogenesi, la classificazione, la diagnosi ed il trattamento di questa condizione.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
CT scan showing rotatory atlanto-axial subluxation with anterior displacement of atlas relative to axis corresponding to Fielding Type II subluxation.
Fig. 2
Fig. 2
Three-dimensional reconstruction of axial CT scan, showing rotatory atlanto-axial subluxation.
Fig. 3
Fig. 3
Three-dimensional reconstruction of axial CT scan showing anterior displacement of atlas relative to axis.
Fig. 4
Fig. 4
Fielding and Hawkins classification of C1-C2 rotary subluxation. Type I: rotatory fixation without anterior displacement of atlas (≤ 3 mm). Type II: rotatory fixation with anterior displacement of atlas of 3-5 mm. Type III: rotatory fixation with anterior displacement of atlas of > 5 mm. Type IV: rotatory fixation with posterior displacement of atlas.
Fig. 5
Fig. 5
Three-dimensional reconstruction of axial CT scan showing lateral tilt of dens in relation to skull base and atlas.
See this image and copyright information in PMC

References

    1. Bell C. The nervous system of the human body, embracing papers to the Royal Society on the subject of nerves. London: Longman, Rees and Orme; 1830. p. 403.
    1. Grisel P. Enucléation de l’atlas et torcicolis nasopharyngien. Presse Médicale 1930;38:50-3.
    1. Fernandez Cornejo VJ, Martinez-Lage JF, Piqueras C, Gelabert A, Poza M. Inflammatory atlanto-axial subluxation (Grisel’s syndrome) in children: clinical diagnosis and management. Childs Nerv Syst 2003;19:342-7. - PubMed
    1. Berry DS, Moriarty RA. Atlanto-axial subluxation related to pharyngitis: Grisel’ syndrome. Clin Pediatr 1999;38:673-5. - PubMed
    1. Baker LL, Bower CM, Glasier CM. Atlanto-axial subluxation and cervical osteomyelitis: two unusual complications of adenoidectomy. Ann Otol Rhinol Laryngol 1996;105:295-9. - PubMed

Publication types