Our Summary

This research paper talks about a rare but serious complication that can occur after ear, nose, and throat (ENT) surgeries, known as atlanto-axial subluxation. This term refers to a misalignment of the first two bones in the neck, which can cause pain and a noticeable tilt in the head.

The authors discuss a case involving a 4-year-old child who developed this condition after getting her adenoids removed. About two and a half weeks after the surgery, she came to the emergency room with her neck tilted to the left and complaining of neck pain that had been going on since the surgery. A specific type of scan confirmed that she had atlanto-axial subluxation.

The child’s condition was managed without surgery. She was given a neck brace, anti-inflammatory medication, and later, a procedure was performed under anesthesia to manually realign her neck bones because her symptoms persisted.

The authors highlight the importance of considering this diagnosis in any child who has had ENT surgery and complains of neck pain or has a persistent head tilt after the surgery. Catching this condition early can reduce the time between when symptoms start and when treatment begins, and it can also lower the risk of needing surgery.

FAQs

  1. What is atlanto-axial subluxation and how can it occur after an adenoidectomy?
  2. How was the case of atlanto-axial subluxation in the 4-year-old child treated?
  3. Why is early diagnosis of atlanto-axial subluxation important after ENT surgical procedures?

Doctor’s Tip

A doctor might tell a patient undergoing adenoidectomy to be aware of any persistent neck pain or changes in neck position after the procedure, as these could be signs of a rare but serious complication called atlanto-axial subluxation. It is important to seek medical attention promptly if these symptoms occur to ensure proper management and prevent potential complications.

Suitable For

Patients who are typically recommended adenoidectomy include those with recurrent or chronic infections of the adenoids, obstructive sleep apnea, chronic nasal congestion or drainage, and chronic ear infections. Additionally, patients with adenoid hypertrophy causing symptoms such as difficulty breathing, snoring, and recurrent sinus infections may also be candidates for adenoidectomy.

Timeline

Before adenoidectomy:

  1. Patient experiences symptoms such as chronic nasal congestion, difficulty breathing through the nose, snoring, recurrent ear infections, and/or sleep apnea.
  2. Patient undergoes evaluation by an otolaryngologist who determines that adenoidectomy is necessary to alleviate symptoms and improve breathing.

After adenoidectomy:

  1. Patient undergoes adenoidectomy surgery, typically done under general anesthesia, to remove the adenoid tissue located at the back of the nasal cavity.
  2. Patient may experience some pain, discomfort, and minor bleeding in the days following surgery.
  3. Patient is typically discharged home the same day as surgery and instructed on post-operative care, such as avoiding strenuous activity and taking pain medication as needed.
  4. Patient may experience improvement in symptoms such as improved breathing, reduced snoring, and decreased frequency of ear infections in the weeks and months following surgery.
  5. In rare cases, such as the case described above, a patient may develop complications such as atlanto-axial subluxation, which requires additional management and follow-up care.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with adenoidectomy, including atlanto-axial subluxation?

  2. How common is atlanto-axial subluxation after adenoidectomy?

  3. What symptoms should I watch for after adenoidectomy that may indicate atlanto-axial subluxation?

  4. How soon after surgery should I seek medical attention if I experience neck pain or stiffness?

  5. What diagnostic tests may be done to confirm a diagnosis of atlanto-axial subluxation?

  6. What treatment options are available for atlanto-axial subluxation, and what is the expected recovery time?

  7. Are there any precautions I should take during the recovery period to prevent atlanto-axial subluxation or other complications?

  8. Will I need any follow-up appointments or imaging studies after adenoidectomy to monitor for potential complications like atlanto-axial subluxation?

  9. How can I ensure a safe and successful recovery from adenoidectomy to minimize the risk of complications like atlanto-axial subluxation?

Reference

Authors: Gross IT, Bahar-Posey L. Journal: Pediatr Emerg Care. 2017 Jun;33(6):416-417. doi: 10.1097/PEC.0000000000001154. PMID: 28570360