Neck pain following adenotonsillectomy: Grisel’s syndrome- C
Adenotonsillectomy is one of the most common surgical procedures performed on children, and postoperative complications are generally uncommon or limited to bleeding episodes.

Grisel’s syndrome, known as a non-traumatic rotatory subluxation of the atlantoaxial joint, is a much less common and poorly understood condition that may occur after otolaryngological surgery or even nasopharyngeal inflammation.

An 8.5-year-old girl presented with a 2-day history of neck pain and stiffness, which began 24 hours after adenotonsillectomy and progressed to functional disability. With the exception of neck stiffness and limited flexo-extensory and rotatory movements, the physical examination was unremarkable.

Computed tomography (CT) scans of the neck revealed atlantoaxial rotatory subluxation, which was better visualized using three-dimensional reconstruction. The patient was placed in a cervical collar, and anti-inflammatory and antibiotic treatments were started. Within 2 weeks, there was a noticeable change in the patient’s condition. Grisel’s syndrome has a pathogenesis that is largely unknown. It has been suggested that inflammation spreads by anastomoses between lymphatic vessels and pharyngo-vertebral veins. Indeed, peripharyngeal septic effusions may enter the pharyngo-vertebral veins and the atlantoaxial joint, causing transverse and alar ligament laxity.

Other authors believe that the spasm of irritated neck muscles caused by the hematogenous spread of inflammatory markers from the pharynx leads to the rotatory subluxation of the atlas in children with a baseline laxity of C1–C2 ligaments.

Despite its rarity, this condition should be considered when dealing with a child who is experiencing neck pain after otolaryngological procedures, as early detection can be critical. Neck CT or MRI must be used to validate clinical suspicion. After anti-inflammatory and antibiotic therapy combined with cervical immobilization, the majority of patients experience complete symptom relief. However, a delayed diagnosis may result in spinal cord compression and possible neurological deficits, as well as the need for neurosurgical vertebral fixation.