Mezue W C, Taha Z M, Bashir E M
Neurosurgery Unit, Hamad General Hospital, Doha, State of Qatar.
J Laryngol Otol. 2002 Apr;116(4):280-4. doi: 10.1258/0022215021910753.
Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel's syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel's syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods. A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS. We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel's syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.
非创伤性寰枢椎半脱位（AAS）所致的急性斜颈常见于患有上呼吸道和颈部炎症性疾病的儿童。格里斯尔综合征是赋予这种病症的名称。这些患者在疾病过程中可能更早出现，而无明显半脱位。因此，早期识别该病症并及时开始适当的保守治疗可阻止其发展为格里斯尔综合征。本研究的目的是强调早期识别可通过保守方法成功治疗的炎性斜颈的重要性。对1996年7月至1998年7月在卡塔尔哈马德总医院神经外科接受治疗的13例发热伴斜颈儿童的病例档案和影像学检查进行了回顾性分析。这些儿童年龄在3至12岁之间，男女比例为3:1。所有患者在斜颈发作后48小时内入院，几乎都有上呼吸道或头颈部感染的表现。通过颈椎X线、计算机断层扫描（CT）或磁共振成像（MRI）进行的影像学检查显示，13例中仅有3例存在AAS。所有患者均接受了保守治疗，包括休息、颈托、单纯镇痛药以及酌情使用抗生素。9例使用了肌肉松弛剂，3例AAS患者接受了颅骨牵引。所有患者对治疗反应良好，无一例因AAS需要手术干预。我们得出结论，大多数急性出现炎性斜颈的儿童仅有旋转畸形而无AAS。如果早期做出诊断并及时开始保守治疗，可避免发展为后者，即格里斯尔综合征。另一方面，诊断延迟会使这些儿童失去接受有效保守治疗的机会。
