Grisel syndrome as a complication after adenoidectomy, case report

Torticollis in paediatric patients is a relatively common symptom. One rare underlying cause is Grisel’s syndrome, a non-traumatic atlanto-axial subluxation that typically develops following nasopharyngeal inflammation or ENT (Ear, Nose, and Throat) surgery. According to the Fielding and Hawkins classification, Grisel’s syndrome is divided into four types based on the degree of subluxation between the atlas and axis vertebrae. While types I to III often respond well to manual repositioning, stages III and IV may require surgical intervention. The subluxation results in notable changes to the myofascial structures of the neck, including reduced range of motion (ROM), muscular spasms, trigger points, and muscle shortening—all of which can be identified during physical examination. Our case study focused on the conservative treatment approach for this syndrome. We employed a goniometer to measure and monitor improvements in joint ROM, and conducted manual muscle length tests to evaluate muscle stretching. Pain levels and treatment outcomes were assessed using the Visual Analog Scale (VAS). Physical medicine and rehabilitation played a critical role in the recovery process. Over a six-month treatment period, we successfully restored ROM, eliminated painful movements, and prevented the development of neurological complications or the need for surgical intervention.