Yu Kathy K, White David R, Weissler Mark C, Pillsbury Harold C
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill 27514, USA.
Laryngoscope. 2003 Jun;113(6):1047-9. doi: 10.1097/00005537-200306000-00024.
At the conclusion of the report, the readers should be able to recognize the rare complication of adenotonsillectomy of Grisel syndrome, discuss its pathogenesis, and provide early, effective treatment.
Analysis of the clinical presentation, plain radiographs, computed tomography scans, and magnetic resonance imaging scans of a child with Grisel syndrome after adenotonsillectomy.
Retrospective study of the case record and a review of the literature regarding the pathogenesis, treatment modalities, outcome, and prognosis after early and delayed treatment of Grisel syndrome.
Pathophysiology of atlantoaxial subluxation revolves around the periodontoid vascular plexus that drains the posterosuperior pharyngeal region. Infectious and inflammatory emboli cause synovial engorgement, weakening paraspinal ligaments. Radiological studies play an important role in diagnosis. Treatment consists of cervical immobilization, muscle relaxants, analgesics, and antibiotics. Full resolution is expected with early conservative management. Failure to recognize the syndrome can lead to catastrophic results.
Recognition of Grisel syndrome in addition to other rare complications of adenotonsillectomy requires a high index of suspicion. Early intervention is the critical factor for a positive outcome. However, delayed diagnosis is common and can result in catastrophic consequences, including neurological deficits, cosmetic deformity and, in rare instances, paralysis and death in the short term.
在本报告结尾，读者应能够识别腺样体扁桃体切除术后罕见的格里塞尔综合征并发症，讨论其发病机制，并提供早期有效的治疗方法。
对一名腺样体扁桃体切除术后发生格里塞尔综合征患儿的临床表现、X线平片、计算机断层扫描和磁共振成像扫描进行分析。
对病例记录进行回顾性研究，并查阅关于格里塞尔综合征发病机制、治疗方式、早期和延迟治疗后的结局及预后的文献。
寰枢椎半脱位的病理生理学围绕着引流咽后上区的齿突周围血管丛。感染性和炎性栓子导致滑膜充血，使椎旁韧带变弱。影像学研究在诊断中起重要作用。治疗包括颈部固定、肌肉松弛剂、镇痛药和抗生素。早期保守治疗有望完全康复。未能识别该综合征可导致灾难性后果。
除了认识腺样体扁桃体切除术后的其他罕见并发症外，识别格里塞尔综合征需要高度的怀疑指数。早期干预是取得良好结局的关键因素。然而，延迟诊断很常见，可能导致灾难性后果，包括神经功能缺损、美容畸形，在极少数情况下，短期内会导致瘫痪和死亡。
