• Isabel Theresia Gross and Laleh Bahar-Posey.
• From the *University of South Florida; and †All Children's Hospital, St Petersburg, FL.
• Pediatr Emerg Care. 2017 Jun 1; 33 (6): 416-417.

AbstractAtlanto-axial subluxation is a rare but potentially serious complication after otolaryngological procedures. We are describing a case of a 4-year-old child who developed atlanto-axial subluxation of the cervical spine after adenoidectomy. Our patient underwent adenoidectomy and, 18 days later, presented to the emergency department with her neck tilted to the left in a cock-robin position and complaining of neck pain persisting since the surgery. A multiplanar 3-dimensional computed tomography was obtained and confirmed the diagnosis of an atlanto-axial subluxation (Fielding type 3). She was managed conservatively with the application of a cervical collar, anti-inflammatory medication, and manual reduction under anesthesia later in the course because of persistence of her symptoms. It is important to consider this diagnosis in any child who undergoes ENT surgical procedures complaining of neck pain subsequent to surgery or holding the head in a fixed position persistently after surgery. Early diagnosis is important to reduce the time between the onset of symptoms and reduction to reduce the risk or need for surgical intervention.

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