La maladie de Grisel: a rare occurrence of "spontaneous" atlanto-axial subluxation after pharyngoplasty.

A review of the literature, with a short discussion of the possible aetiology, diagnosis and treatment of "la maladie de Grisel" is presented with a case report of atlanto-axial subluxation occurring in a child after pharyngoplasty. The occurrence of a "spontaneous" subluxation after pharyngoplasty has not been previously reported. The possible scale of neurological complications which may range from relatively minor nerve root compression to a potentially lethal major cord compression emphasises the importance of this condition especially as a minor trauma may precipitate a major disaster. We would like to draw attention to this unusual complication because some neck pain and stiffness are quite usual after pharyngoplasty and we would stress that persisting symptoms associated with a torticollis after any operation in the oral cavity or pharynx should alert the surgeon to this diagnosis. The establishment of early treatment may avert a neurological calamity.