Grisel Syndrome as a Complication of a Parapharyngeal Abscess

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Nuno Medeiros - Corresponding Author

Nuno Medeiros []
Rua Mestre Guilherme Camarinha 94 H1.4, Porto, Portugal
ORCID iD: 0000-0003-3127-9406

Pedro Valente
Cristina Aguiar
João Larangeiro
Artur Condé


INTRODUCTION: Grisel syndrome is a rare entity that corresponds to a non-traumatic atlantoaxial rotatory subluxation, usually secondary either to an infection of the upper airway or to a head and neck procedure. Patients usually present with torticollis, and a high index of suspicion is needed for correct diagnosis.
CASE REPORT: A 6-year-old boy was admitted to the ER with sore throat, fever, and torticollis. Clinical examination revealed neck flexion with rotation to the right. Computed tomography scan revealed a parapharyngeal abscess and an anterior displacement of the atlanto-axial joint of 3 mm, configuring a type II of Fielding. The child was admitted for endovenous antibiotic treatment, surveillance, and cervical immobilization.
DISCUSSION: Grisel syndrome may present in a child with torticollis and neck infection. Otorhinolaryngologists should remember the possible presentations and risk factors for this syndrome. Conservative treatment is often enough, and early identification and immobilization seem to lead to better outcomes.

Keywords: Atlanto-Axial Joint; Child; Joint Dislocations; Retropharyngeal Abscess; Torticollis

Article Details

Medeiros N, Valente P, Aguiar C, Larangeiro J, Condé A. Grisel Syndrome as a Complication of a Parapharyngeal Abscess. Gaz Med [Internet]. 2021 Mar. 31 [cited 2022 Jan. 23];8(1). Available from:

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