Retropharyngeal abscess causing grisel’s syndrome secondary to tuberculosis of cervical spine, a rare form of torticollis: case report


  • Reegina Sivarajan Department of Otorhinolaryngology, Hospital Keningau, Sabah, Malaysia
  • Mohammad Fuaz Mahfuz Department of Otorhinolaryngology, Hospital Keningau, Sabah, Malaysia
  • Siti Hajar Sanudin Department of Otorhinolaryngology Head and Neck Surgery, Queen Elizabeth Hospital, Sabah, Malaysia



Grisel’s syndrome, Atlantoaxial subluxation, Retropharyngeal abscess, Tuberculosis


Grisel’s syndrome is a rare type of non-traumatic subluxation of an atlantoaxial joint characterized by torticollis, neck pain, and reduced neck movement. The common causes of Grisel’s syndrome are head and neck infection or post-otorhinolaryngology (ORL) procedures. We are reporting a case of a 3-year-old boy with a gradual worsening of neck stiffness, neck pain, and restricted neck movement for more than one month. The patient had no history of trauma. The computerized tomographic (CT) showed a retropharyngeal abscess with a bony erosion causing atlantoaxial subluxation. The management and progress of this patient are discussed. The objective of this case report is to emphasize that Grisel’s syndrome should be considered a differential in a painful torticollis to prompt an early diagnosis and treatment to prevent serious neurological complications.


Allegrini D, Autelitano A, Nocerino E, Fogagnolo P, De Cillà S, Rossetti L. Grisel's syndrome, a rare cause of anomalous head posture in children: a case report. BMC Ophthalmol. 2016;16:21.

Barcelos AC, Patriota GC, Netto AU. Nontraumatic atlantoaxial rotatory subluxation: grisel syndrome. Case report and literature review. Global Spine J. 2014 Aug;4(3):179-86.

Bocciolini C, Dall'Olio D, Cunsolo E, Cavazzuti PP, Laudadio P. Grisel's syndrome: a rare complication following adenoidectomy. Acta Otorhinolaryngol Ital. 2005 Aug;25(4):245-9.

Bucak A, Ulu S, Aycicek A, Kacar E, Miman MC. Grisel's Syndrome: A Rare Complication following Adenotonsillectomy. Case Rep Otolaryngol. 2014:703021.

Lee JK, Oh CH, Park HC, Yoon SH. Grisel's Syndrome Induced by Mycobacterium tuberculosis. Korean J Spine. 2015 Jun;12(2):84-7.

Aladag Ciftdemir N, Eren T, Ciftdemir M. A Rare Cause of Torticollis: Grisel Syndrome. J Trop Pediatr. 2018 Jun 1;64(3):245-8.

Shunmugam M, Poonnoose S. Spontaneous atlantoaxial subluxation associated with tonsillitis. Asian J Neurosurg. 2015 Apr-Jun;10(2):139-41.

Bilgin E, Çavuş G, Açık V, Gezercan Y, Ökten Aİ. Grisel`s syndrome presenting with neck pain: an atypical case. Turk J Pediatr. 2020;62(1):141-5.

Dagtekin A, Kara E, Vayisoglu Y, Koseoglu A, Avci E, Talas D, et al. The importance of early diagnosis and appropriate treatment in Grisel's syndrome: report of two cases. Turk Neurosurg. 2011;21(4):680-4.

Park SH, Park SH, Lee SH. Grisel syndrome: pathophysiological evidence from magnetic resonance imaging findings. Ann Rehabil Med. 2013 Oct;37(5):713-6.

Fernández Cornejo VJ, Martínez-Lage JF, Piqueras C, Gelabert A, Poza M. Inflammatory atlanto-axial subluxation (Grisel's syndrome) in children: clinical diagnosis and management. Childs Nerv Syst. 2003;19(5-6):342-7.

Subach BR, McLaughlin MR, Albright AL, Pollack IF. Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976). 1998;23(20):2174-9.

Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59(1):37-44.

Jain R, Sawhney S, Berry M. Computed tomography of vertebral tuberculosis: patterns of bone destruction. Clin Radiol. 1993 Mar;47(3):196-9.

Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal tuberculosis: diagnosis and management. Asian Spine J. 2012;6(4):294-308.

Goroh MMD, Rajahram GS, Avoi R, Van Den Boogaard CHA, William T, Ralph AP, et al. Epidemiology of tuberculosis in Sabah, Malaysia, 2012-2018. Infect Dis Poverty. 2020;9(1):119.

Clinical Practical Guideline. Management of Tuberculosis, 2012. Available at: Accessed on 1 January 2021.






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