A Rare Case of Grisel's Syndrome in A 6-Year-Old Child

C1-2 rotatory subluxation is more commonly seen in children compared to in adults. It often has a history of respiratory tract infection, cervical trauma, and recent history of surgery of the head or neck.

A 6-year-old boy presented to us with complaints of insidious onset of progressive deformity of the neck since the past 3 months. On examination, the patient had a classic "cock robin" deformity with his left head tilt and right-sided chin rotation. There was tenderness and spasm of the left sternocleidomastoid muscle. Radiologically, the child had unilateral C1-C2 facetal dislocation. There were associated abnormalities consisting of unilateral occiputoatlantal fusion and C2-C3 fusion. Magnetic resonance imaging (MRI) showed C1-C2 subluxation with kyphotic deformity the apex of which was impinging on the brainstem. The patient was put on skull traction with Crutchfield Tongs with progressively increasing weights for 1 week and serial X-rays were taken. Computed tomography (CT) scan was repeated at the end of 1 week which showed no improvement. C1-C2 open reduction and fusion was done. Post-operative period was uneventful. He improved on serial follow-ups. At follow-up at 18 months, the child remains comfortable, is going to school and doing all indoor and outdoor activities. His posture continues to be balanced. Radiologically, C1-C2 joint shows signs of a solid fusion.

A thorough history taking and a meticulous clinical examination if important for evaluation of torticollis in a child. Proper imaging helps in confirming the diagnosis and grading the severity. Prompt treatment is necessary for getting a good outcome.