Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Unexpected postoperative atlantoaxial rotatory subluxation after excision of melanocytic nevi of the head and neck in older children: two case reports and literature review

  • Jiwon Kang (Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Byung Jun Kim (Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2023.09.13
  • Accepted : 2024.04.09
  • Published : 2024.04.20
Download PDF
⟨ Previous Next ⟩

Abstract

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

Keywords

References

  1. Sangermani R, Micheloni F, Partesana A, Cammarata C, Pacilli P, Lucchini F. Grisel's syndrome. Description of a case of spontaneous subluxation of the atlas. Pediatr Med Chir 1986;8:735-6.
  2. Robinson PH, De Boer A. La maladie de Grisel: a rare occurrence of "spontaneous" atlanto-axial subluxation after pharyngoplasty. Br J Plast Surg 1981;34:319-21. https://doi.org/10.1016/0007-1226(81)90020-5
  3. Eadie PA, Moran R, Fogarty EE, Edwards GE. Rotatory atlantoaxial subluxation following pharyngoplasty. Br J Plast Surg 1989;42:722-3. https://doi.org/10.1016/0007-1226(89)90089-1
  4. Sakaida H, Akeda K, Sudo A, Takeuchi K. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: report of two cases in young children. Patient Saf Surg 2017;11:5.
  5. Parke WW, Rothman RH, Brown MD. The pharyngovertebral veins: an anatomical rationale for Grisel's syndrome. J Bone Joint Surg Am 1984;66:568-74. https://doi.org/10.2106/00004623-198466040-00012
  6. Kelly EJ, Herbert KJ, Crotty EJ, O'Connor TP. Atlantoaxial subluxation after otoplasty. Plast Reconstr Surg 1998;102:543-4. https://doi.org/10.1097/00006534-199808000-00040
  7. Cekinmez M, Tufan K, Sen O, Caner H. Non-traumatic atlanto-axial subluxation: Grisel's syndrome. Two case reports. Neurol Med Chir (Tokyo) 2009;49:172-4. https://doi.org/10.2176/nmc.49.172
  8. Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG. A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 2014;4:197-210. https://doi.org/10.1055/s-0034-1376371
  9. Welinder NR, Hoffmann P, Hakansson S. Pathogenesis of non-traumatic atlanto-axial subluxation (Grisel's syndrome). Eur Arch Otorhinolaryngol 1997;254:251-4. https://doi.org/10.1007/BF00874099
  10. Kim B, Iwata K, Sugimoto K, Suzuki S, Ema Y, Tsunobuchi H, et al. Significance of prevention and early treatment of a postoperative twisted neck: atlantoaxial rotatory subluxation after head and neck surgery. J Anesth 2010;24:598-602. https://doi.org/10.1007/s00540-010-0932-3
  11. Pedro KM, Gaddi MJ, Sih IM. Iatrogenic atlantoaxial rotatory subluxation after spinal manipulative therapy in a child. Interdiscip Neurosurg 2020;21:100721.
  12. Dowdell J, Mikhail C, Robinson J, Allen A. Anatomy of the pediatric spine and spine injuries in young athletes. Ann Jt 2018;3:1-10. https://doi.org/10.21037/aoj.2017.12.05
  13. Nightingale RW, Winkelstein BA, Van Ee CA, Myers BS. Injury mechanisms in the pediatric cervical spine during out-of-position airbag deployments. Annu Proc Assoc Adv Automot Med 1998;42:153-64.
  14. Abelin-Genevois K, Idjerouidene A, Roussouly P, Vital JM, Garin C. Cervical spine alignment in the pediatric population: a radiographic normative study of 150 asymptomatic patients. Eur Spine J 2014;23:1442-8. https://doi.org/10.1007/s00586-013-3150-5
  15. Subach BR, McLaughlin MR, Albright AL, Pollack IF. Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976) 1998;23:2174-9. https://doi.org/10.1097/00007632-199810150-00006
  16. Osmotherly PG, Farrell SF, Digby SD, Rowe LJ, Buxton AJ. The influence of age, sex, and posture on the measurement of atlantodental interval in a normal population. J Manipulative Physiol Ther 2013;36:226-31. https://doi.org/10.1016/j.jmpt.2013.04.004
  17. Bertozzi JC, Rojas CA, Martinez CR. Evaluation of the pediatric craniocervical junction on MDCT. AJR Am J Roentgenol 2009;192:26-31. https://doi.org/10.2214/AJR.08.1058
  18. Douglas TS, Sanders V, Machers S, Pitcher R, van As AB. Digital radiographic measurement of the atlantodental interval in children. J Pediatr Orthop 2007;27:23-6. https://doi.org/10.1097/01.bpo.0000242443.42176.67
  19. Deliganis AV, Baxter AB, Hanson JA, Fisher DJ, Cohen WA, Wilson AJ, et al. Radiologic spectrum of craniocervical distraction injuries. Radiographics 2000;20 Spec No:S237-50. https://doi.org/10.1148/radiographics.20.suppl_1.g00oc23s237
  20. Spoor AB, Diekerhof CH, Bonnet M, Oner FC. Traumatic complex dislocation of the atlanto-axial joint with odontoid and C2 superior articular facet fracture. Spine (Phila Pa 1976) 2008;33:E708-11. https://doi.org/10.1097/BRS.0b013e31817c140d
  21. Shetty A, Kumar A, Chacko A, Guthe S, Kini AR. Reduction techniques in the management of atlantoaxial subluxation. Indian J Orthop 2013;47:333-9. https://doi.org/10.4103/0019-5413.114908
  22. McGuire KJ, Silber J, Flynn JM, Levine M, Dormans JP. Torticollis in children: can dynamic computed tomography help determine severity and treatment. J Pediatr Orthop 2002;22:766-70.
  23. Phillips WA, Hensinger RN. The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 1989;71:664-8. https://doi.org/10.2106/00004623-198971050-00004
  24. Pang D, Li V. Atlantoaxial rotatory fixation: part 2. New diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery 2005;57:941-53. https://doi.org/10.1227/01.NEU.0000181309.13211.3A
  25. Ishii K, Matsumoto M, Momoshima S, Watanabe K, Tsuji T, Takaishi H, et al. Remodeling of C2 facet deformity prevents recurrent subluxation in patients with chronic atlantoaxial rotatory fixation: a novel strategy for treatment of chronic atlantoaxial rotatory fixation. Spine (Phila Pa 1976) 2011;36:E256-62. https://doi.org/10.1097/BRS.0b013e3181d8bbdd
  26. Alanay A, Hicazi A, Acaroglu E, Yazici M, Aksoy C, Cila A, et al. Reliability and necessity of dynamic computerized tomography in diagnosis of atlantoaxial rotatory subluxation. J Pediatr Orthop 2002;22:763-5.
  27. Dickman CA, Mamourian A, Sonntag VK, Drayer BP. Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 1991;75:221-7. https://doi.org/10.3171/jns.1991.75.2.0221
  28. Wenger KJ, Hattingen E, Porto L. Magnetic resonance imaging as the primary imaging modality in children presenting with inflammatory nontraumatic atlantoaxial rotatory subluxation. Children (Basel) 2021;8:329.
  29. Rahimi SY, Stevens EA, Yeh DJ, Flannery AM, Choudhri HF, Lee MR. Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 2003;15:ECP1.
  30. Neal KM, Mohamed AS. Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg 2015;23:382-92. https://doi.org/10.5435/JAAOS-D-14-00115
  31. Schwarz N. The fate of missed atlanto-axial rotatory subluxation in children. Arch Orthop Trauma Surg 1998;117:288-9. https://doi.org/10.1007/s004020050249
  32. Chu EC, Lo FS, Bhaumik A. Plausible impact of forward head posture on upper cervical spine stability. J Family Med Prim Care 2020;9:2517-20. https://doi.org/10.4103/jfmpc.jfmpc_95_20
  33. Saito W, Imura T, Ueno M, Nakazawa T, Takahira N, Takaso M. Severe cervical kyphotic deformity caused by postural disorders in a child with schizophrenia. Spine J 2013;13:e37-43. https://doi.org/10.1016/j.spinee.2013.05.016
  34. Ibrahimi OA, Alikhan A, Eisen DB. Congenital melanocytic nevi: where are we now? Part II. Treatment options and approach to treatment. J Am Acad Dermatol 2012;67:515.e1-13. https://doi.org/10.1016/j.jaad.2011.11.936
  35. Schaffer JV. Update on melanocytic nevi in children. Clin Dermatol 2015;33:368-86. https://doi.org/10.1016/j.clindermatol.2014.12.015
  36. Choi Y, Sung KP, Lee SH. Simultaneous diagnosis and resection of orofacial rhabdomyosarcoma with frozen section biopsy: a case report. Arch Craniofac Surg 2023;24:185-8. https://doi.org/10.7181/acfs.2023.00052
  37. Kim TH, Choi JW, Jeong WS. Current concepts of vascular anomalies. Arch Craniofac Surg 2023;24:145-58. https://doi.org/10.7181/acfs.2023.00332
  38. Ghanem I, El Hage S, Rachkidi R, Kharrat K, Dagher F, Kreichati G. Pediatric cervical spine instability. J Child Orthop 2008;2:71-84.