Pediatric Surgery International

, Volume 16, Issue 5–6, pp 421–423 | Cite as

Rotary atlanto-axial subluxation with torticollis following central-venous catheter insertion

  • Paul Brisson
  • Haroon Patel
  • Ronald Scorpio
  • Neil Feins
CASE REPORT

Abstract

Atlanto-axial subluxation with torticollis is an uncommon condition that occurs in children usually as a result of pharyngeal infection, minor trauma, or neck surgery. Passive motion of the head and neck during general anesthesia is probably another etiologic factor. Torticollis is the most common presenting physical finding. Pain may or may not be present, but is commonly present with passive neck motion. Neurologic sequelae are uncommon. Our case illustrates this condition as a complication of central venous catheter (CVC) insertion in a child under general anesthesia. The surgeon should suspect this pathology when a child presents with torticollis following CVC placement. Precautions should be taken in the operating room to avoid aggressive rotation and extension of the child's neck while under general anesthesia whether or not cervical inflammation is present. Special attention to head and neck positioning should be taken in patients with Down's syndrome since they are at increased risk for atlanto-axial subluxation. The prognosis is excellent when diagnosed early. A delay in diagnosis can result in the need for surgical intervention.

Key words Cervical spine Subluxation Torticollis Central venous catheter 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • Paul Brisson
    • 1
  • Haroon Patel
    • 1
  • Ronald Scorpio
    • 1
  • Neil Feins
    • 1
  1. 1.The Floating Hospital for Children, New England Medical Center, 750 Washington Street, Boston, MA 02111, USAGB

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