Griesel's syndrome

Griesel’s syndrome is a rare pathology characterised by a rotatory atlo-axial subluxation, secondary to oro-rhino-pharingeal inflammatory processes diffused in the prevertebral region by the lymphatic way. Similar cases have also been observed after adeno-tonsillar surgery. The maximum incidence is placed between 6 and 12 years old. Fielding and coll. in 1977 elaborated a classification, still used actually, that defines, according to an increasing gravity criterion, 4 types of atlo-occipital subluxation. The primary treatment is based on a specific antibiotic therapy. The subluxation is also reduced with physiotherapy. The interest for this syndrome is due to the fact that constitutes, in chronic cases mostly, a real model of study for the integrated system cranio-cervical-mandibular apparatus, and offers the possibility to valuate the repercussions on this system, of primary alterations appeared at the cervical column. The Authors report 4 cases (2 males and 2 females), between 8 and 12 years old, affected from Grisel`s syndrome. Three patients have been previously treated in neurosurgery department .In the fourth cases , the patient was affected by a cronic form and hasn’t been previously treated. In the last case, a detailed, aimed diagnostic study has been executed, in order to estimate the repercussions of the severe atlo-occipital alteration on the muscular and skeletal cranio-cervical-maxillo-mandibular system. In the first three cases the effects of the atlo-occipital alterations on the muscular and skeletal cranio-facial system appeared during infancy. The analysis of the clinical elements of these three cases demonstrated in an unquestionable way that the whole muscular and skeletal structures of the cranio-maxillo-mandibular-joid-cervical-vertebral region is an integrate system. From the study of the fourth case, where the alterations were chronic, the Authors can observe how the stabilization of the process, and so the atlo-occipital asymmetry of the skull-base, can evolve exciting muscular and skeletal asymmetries and occlusal alterations. In this specific case there was a mandibular asymmetry with cross-bite and unilateral subluxation of the temporomandibular joint.