Iris Publishers - Open access journal of Otolaryngology and Rhinology | Grisel Syndrome: A Rare Complication of Pediatric Adenotonsillectomy

Authored by Enrico Maria Amadei

We present our casuistry of pediatric adenotonsillectomies carried out during the period 2009-2018. We report our experience about a rare and often not quickly recognized complication the Grisel syndrome. This consists of a non-traumatic atlantoaxial subluxation with inflammation in adjacent soft tissues. We performed 1231 paediatric adenotonsillectomies and we found 4 cases of Grisel syndrome. We discuss the diagnosis and treatment of this complication.

We report our casuistry of 1231 pediatric adenotonsillectomies. All were performed at our Hospital during the period 2009-2018 by the same surgeon. In adult patients adenoidectomy is rarely indicated. The main indication for tonsillectomy is given by recurring inflammations/infections. From international guidelines the indication is given by 5 or more episodes of tonsillitis per year, for at least 2 consecutive years [1]. In pediatric patients, on the other hand, the main indication for adenoidectomy is given by nasal breathing difficulty and by recurrent acute or chronic otitis. The indication for tonsillectomy is essentially represented by obstruction of the upper airways caused by hypertrophic tonsils, with consequent night snoring and sleep apnea. Adenotonsillectomy is a routine surgery for an otolaryngologist, but never trivial. In fact, there are many transient problems after surgery: these are mainly represented by the difficulty in swallowing, halitosis, fever, earache, post-tonsillectomy hemorrhage. This last complication has an incidence in our casuistry of 3% per year, as in the international case studies. In 4 cases we found a persistent torcicollis.

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