Atlanto-axial rotatory fixation: a serious potential complication of paediatric ENT surgery that requires prompt diagnosis and treatment

作者：James G^*; Thompson D N P

来源：Journal of Laryngology and Otology, 2017, 131(11): 940-945.

DOI：10.1017/S0022215117001918

• Atlanto-Axial Joint
• Torticollis
• Otorhinolaryngologic Surgical Procedures
• Iatrogenic Disease

Background: Atlanto-axial rotatory fixation is a persistent deformity of the C1-2 vertebral relationship caused by subluxation of the articular surfaces, and can occur after positioning for ENT procedures where the head is rotated - for example to access the ear or posterior triangle of the neck. If promptly recognised, it can usually be managed successfully with conservative methods, without long-lasting sequelae, but delayed or inappropriate management may lead to permanent neck deformity, neurological problems and pain.
Method: Case review.
Case report: Two children with atlanto-axial rotatory fixation following ENT surgery; one child was referred early and managed successfully, and one had delayed referral resulting in permanent severe positional deformity.
Conclusion: Atlanto-axial rotatory fixation is easily missed; there are significant clinical and medicolegal implications if it is not promptly recognised. A suggested management algorithm is presented.

• 出版日期2017-11