This disorder is the result of an inflammatory lesion, and the literature reports a higher incidence in children under 13 years of age.
The atlanto-axial joint consists of the anterior arch and transverse ligament of the atlanto-axial spine and the dentate process of the cardinal spine and is located posterior to the posterior pharyngeal wall. The posterior pharyngeal wall is rich in lymph nodes and lymphoid tissue. The lymph from the cervical 1, 2 and nasopharynx, tonsils, middle ear and nasal cavity are grouped together into the posterior pharyngeal lymph nodes and then into the deep cervical lymph nodes. For example, tonsillitis, otitis media, nasopharyngitis, parotitis, cervical lymphadenitis, etc. can cause lymphadenitis in the posterior pharyngeal wall, causing reactive arthritis in the adjacent atlantoaxial joint, resulting in joint effusion and relaxation of the transverse ligament, leading to subluxation of the atlantoaxial joint. Zhang Guichun, Department of Orthopedic Trauma, Jinan Military General Hospital
The onset of the disease is slow, with neck pain and slanting neck, and the child supports his jaw with his hand. Stiff neck, sternocleidomastoid muscle spasm, head tilted to one side, limited movement, pressure pain at the back of the neck and atlantoaxial joint. There may be pressure pain in the cervical lymph nodes or submaxillary lymph nodes, and there are signs of inflammation in the throat. X-ray examination: C1-2 is a central lateral film, and the atlas-dens interval (ADI) is measured at a normal value of 3 mm for adults and 4 mm for children. The open mouth film shows unequal distance (ADI) between the dentition and the lateral block, with rotational subluxation.
Treatment: (l) Traction with a collar-occipital sling (four-headed) in bed. Generally, after 2 weeks of continuous traction, the neck is protected with a neck collar for 4 to 6 weeks. (2) Anti-infection treatment, available in appropriate amounts of antibacterial agents. This disease, after treatment, can generally be cured.
Note: The name of atlantoaxial subluxation is debated in medicine, and it is also called atlantoaxial instability.