Atlanto-Axial Rotatory Subluxation

• Acquired torticollis of unknown cause
• Inflammatory and/or traumatic etiology are suspected
• Grisel’s syndrome – Nasopharyngeal inflammation leading to atlanto-axial instability secondary to hyperemia and edema
• Seen primarily in the pediatric population
• Must rule out other acquired causes of torticollis
• Neurologic – posterior fossa or cervical cord tumor
• Orthopedic – tumor or infection of upper ribs, cervical spine
• GI – gastroesophageal reflux (Sandifer syndrome)
• Treatment:
• Analgesics, muscle relaxants and collar
• Consider cervical halter traction if present > 1 week
• May require cervical fusion if refractory or recurrent