Intraoperative Use of Cone-Beam Computed Tomography in the Treatment of Atlantoaxial Rotatory Subluxation.

BACKGROUND

Atlantoaxial rotatory subluxation (AARS) is a rare pathological condition of the upper cervical spine. It can be caused by multiple mechanisms, including minor neck manipulations. Children are more prone owing to the weaker periarticular soft tissue and a steeper slant of the C1 facet plane against the vertical axis of the dens. If AARS does not resolve spontaneously, a normal position of the atlantoaxial joint must be achieved by reduction and stabilization.

CASE DESCRIPTION: A 15-year-old girl had presented with a painful torticollis that had already been present for 4 weeks after trimaxillary jaw correction for skeletal class II malocclusion. A computed tomography (CT) scan of the cervical spine showed AARS Field and Hawkins classification type I. We first attempted 1 week of conservative treatment with a soft collar and the prescription of a muscular relaxant. However, because the AARS persisted, we performed transoral closed reduction with the patient under general anesthesia, as previously described. During the procedure, we used intraoperative cone-beam CT to evaluate the degree of reduction. After obtaining complete reduction, immobilization with a halo-vest was applied.

CONCLUSIONS

Complete reduction of the AARS was achieved with closed intraoral reduction. We used intraoperative cone-beam CT to confirm complete reduction. We found cone-beam CT to be a very useful tool.