Combined tonsillar reflex zone stimulation and four-step manipulative reduction for Grisel syndrome following pediatric adenotonsillectomy: a case report.

BACKGROUND

Grisel syndrome (GS), also referred to as nontraumatic atlantoaxial subluxation, is typically associated with head and neck infections, inflammation, or postoperative complications. Its clinical manifestations include torticollis, neck pain and stiffness, restricted cervical mobility, and muscle spasms. Based on the pathological features of GS following tonsillectomy and adenoidectomy, as well as the anatomical relationship between the palatine tonsils and the atlantoaxial joint, this report proposes a therapeutic approach combining manual stimulation of the tonsillar reflex zone with a four-step atlantoaxial manipulative reduction for the management of this condition.

METHODS

A 7-year-old Chinese boy presented with neck pain, cervical deviation, and restricted range of motion persisting for over two weeks. The patient demonstrated marked limitation in left cervical rotation, with mild restrictions in right rotation, flexion, and extension. Based on the patient's clinical presentation, the primary therapeutic intervention consisted of manual stimulation of the tonsillar reflex zone combined with an atlantoaxial manipulative reduction protocol.

RESULTS

After nine days of treatment, the patient demonstrated resolution of cervical pain with improvement in cervical flexion, extension, and rotational movements. Tonsillar region discomfort had also significantly resolved. At the 15-day follow-up assessment, both cervical alignment and functional mobility were restored to normal physiological parameters, with no recurrence of tonsillar or cervical pain reported.

CONCLUSION

This clinical case demonstrates that manual stimulation of the tonsillar region can alleviate local inflammation, while combined with cervical soft tissue relaxation and atlas-axis joint reduction to restore normal anatomical alignment. This integrated protocol successfully achieved therapeutic goals for this condition.