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Clinical Problem Solving: Radiology
Feb 2012

Radiology Quiz Case 2: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2012;138(2):200-201. doi:10.1001/archoto.2011.1193b

Diagnosis: Nontraumatic atlantoaxial subluxation (also known as Grisel syndrome)

Grisel syndrome, or nasopharyngeal torticollis, is a nontraumatic atlantoaxial subluxation. Initially identified by Sir Charles Bell in 1830 in a patient with a syphilitic ulceration of the pharynx and later studied in children by Pierre Grisel1 in 1930, the process was more frequently encountered in the preantibiotic era. Grisel syndrome is a rare complication that is most commonly related to infections of the upper aerodigestive tract as well as to operative procedures in that anatomical region, including tonsillectomy, adenoidectomy, choanal atresia repair, mastoidectomy, and cleft palate repair. The diagnosis of Grisel syndrome must be considered in any child who presents with acute torticollis after either an infection or surgical manipulation of the upper aerodigestive tract. Although this uncommon entity can present in adults, it is primarily a pediatric disease. In 75% to 85% of all cases, children younger than 13 years are affected,2 at least in part because of the greater vascularity of the atlas and the increased frequency of upper aerodigestive tract infections in children.3