Chua Andy J K, Tan Bernard W S, Tan Tiong Yong, Heah Harold H W
Department of Otolaryngology Singapore General Hospital Singapore Singapore.
Department of Radiology Changi General Hospital Singapore Singapore.
Laryngoscope Investig Otolaryngol. 2019 Aug 13;4(5):504-507. doi: 10.1002/lio2.298. eCollection 2019 Oct.
Grisel's syndrome is rare in adults, and is characterized by nontraumatic atlanto-axial subluxation secondary to infection. Here, we report a case of Grisel's syndrome occurring after endoscopic nasopharyngectomy.
A 67-year-old man complained of fever and neck pain with reduced lateral rotation after an endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Flexion and extension X-rays of the cervical spine demonstrated atlanto-axial subluxation, and magnetic resonance imaging showed infective changes with cervical osteomyelitis. A diagnosis of Grisel's syndrome with cervical spine osteomyelitis was made. A later computed tomography (CT) scan demonstrated subluxation of C1 on C2, as well as the occipital-C1 joint.
The patient was treated with intravenous antibiotics and offered surgery for spinal stabilization, but declined. He remained well 15 months post-op on a cervical collar with minimal pain and no neurologic deficits.
A high index of suspicion for Grisel's syndrome is suggested in patients who have neck pain with reduced range of motion postnasopharyngectomy, and imaging is useful in clinching the diagnosis.
格里斯尔综合征在成人中罕见，其特征为继发于感染的非创伤性寰枢椎半脱位。在此，我们报告1例内镜下鼻咽癌切除术后发生的格里斯尔综合征病例。
一名67岁男性因复发性鼻咽癌接受内镜下鼻咽癌切除术后，出现发热、颈部疼痛且侧方旋转受限。颈椎屈伸位X线片显示寰枢椎半脱位，磁共振成像显示伴有颈椎骨髓炎的感染性改变。诊断为伴有颈椎骨髓炎的格里斯尔综合征。随后的计算机断层扫描（CT）显示C1相对于C2以及枕- C1关节半脱位。
患者接受静脉抗生素治疗，并被建议行手术以稳定脊柱，但患者拒绝。术后15个月，患者佩戴颈托情况良好，疼痛轻微，无神经功能缺损。
对于鼻咽癌切除术后出现颈部疼痛且活动范围减小的患者，建议高度怀疑格里斯尔综合征，影像学检查有助于确诊。
4级。
