Grisel's syndrome is a non-traumatic atlantoaxial subluxation that may complicate upper respiratory tract infections and adenotonsillectomy. The pathophysiology involves:

• A Direct pyogenic infection of the transverse atlantal ligament causing ligamentous laxity
• B Traction injury to the transverse ligament during tonsillectomy traction on the jaw
• C Inflammatory hyperaemia and ligamentous laxity transmitted via pharyngovertebral venous plexus from adjacent infected/inflamed tissues to atlantoaxial ligaments ✓
• D Septic embolism to the atlantoaxial joint causing osteomyelitis

Explanation

Grisel's syndrome (non-traumatic atlantoaxial subluxation) is thought to result from inflammatory hyperaemia and softening of the paravertebral ligaments, particularly the transverse atlantal ligament and alar ligaments, due to spread of infection/inflammation from the adjacent nasopharynx via the pharyngovertebral venous plexus and direct lymphatic spread. This leads to ligamentous laxity and atlantoaxial rotatory subluxation. It presents with torticollis (cock-robin posture) and neck pain after throat infections or adenotonsillectomy. MRI/CT is diagnostic; management is traction and anti-inflammatory treatment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.