Turkish Neurosurgery
The Importance of Early Diagnosis and Appropriate Treatment in Grisel’s Syndrome: Report of Two Cases
Ahmet Dagtekin1, Engin Kara2, Yusuf Vayisoglu3, Aslihan Koseoglu1, Emel Avci1, Derya Talas3, Celal Bagdatoglu1
1 UNIVERSITY of MERSIN SCHOOL of MEDICINE, NEUROSURGERY DEPARTMENT, Mersin,
2 UNIVERSITY of MERSIN SCHOOL of MEDICINE, RADIOLOGY DEPARTMENT, Mersin,
3 UNIVERSITY of MERSIN SCHOOL of MEDICINE, OTORHINOLARYNGOLOGY DEPARTMENT, Mersin,
DOI: 10.5137/1019-5149.JTN.3120-10.1

Grisel’s syndrome designates subluxation of atlanto-axial joint unrelated to trauma or bone disease. Atlanto-axial subluxation is seen after the upper neck inflammatory processes of head and neck region. Moreover, this rare clinical entity has been observed after various otolaryngological surgical approaches including adenoidectomy, tonsillectomy and mastoidectomy. Eight year-old girl and 14 year-old boy presented with complaints of painful torticollis. First patient was operated in another health center due to adenoid hypertrophy. She was referred to our clinic in the postoperative 5th day with painful torticollis. The diagnosis was established by computerized tomography and three-dimensional reconstructions. Second patient had a history of throat infection. Radiological investigation demonstrated atlanto-axial subluxation. The patients were treated with external fixation, antibiotic therapy, muscle relaxants, and anti-inflammatory therapy. Early diagnosis and appropriate treatment resulted in a good outcome in our patients. Grisel’s syndrome must be considered in differential diagnosis in children with painful torticollis associated with upper respiratory tract infection and after various otolaryngological surgical procedures. We report two cases of Grisel’s syndrome which emphasize on the importance of early diagnosis for appropriate and successful treatment.

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