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グリゼル症候群の耳鼻咽喉科後の処置。システマティックレビュー
Grisel's syndrome post otolaryngology procedures: A systematic review.
PMID: 32658805 DOI: 10.1016/j.ijporl.2020.110225.
抄録
目的:
耳鼻咽喉科手術後の耳鼻咽喉科医のグリセル症候群に対する意識と疑惑の指標を高めること。
OBJECTIVE: To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures.
方法:
METHOD: We conducted a search of MEDLINE/PubMed for articles published through January 2020 utilizing the following terms: Grisel's syndrome, Grisel syndrome, and atlantoaxial subluxation alone and in combination with other terms like ENT, otolaryngology, head & neck, tonsillectomy, adenoidectomy, adenotonsillectomy, mastoidectomy, tympanoplasty, and tympanomastoidectomy. We included English-language cases that occurred after surgical procedures and contained the following data: age, onset, common presenting symptoms, diagnostic approach, management options, and the presence of complications.
結果:
我々の基準を満たす論文が39件見つかりました。ほとんどの症例は、換気管挿入の有無にかかわらず、腺扁桃腺摘出術後に発生した（55.6％）。症例の大部分は小児年齢層であり、主な症状は早期発症のトルチコラーゼであった。管理については、ほとんどの症例で内科的治療が行われ、補助的な処置（例：頚椎カラー）の有無にかかわらず、治療が行われた。神経学的合併症は、長期的な後遺症のない1例を除いて記録されていない。
RESULT: We found 39 papers that met our criteria. Most cases occurred after adenotonsillectomy with or without ventilation tube insertion (55.6%). The majority of the affected population was the pediatric age group, and the main presenting symptom was torticollis that presents as early-onset. In regard to management, most of the cases were treated with medical therapy with or without adjunctive measures (e.g., a cervical collar). No neurological complications were recorded except in one case that was treated with no long term sequel.
結論:
グリゼル症候群は、耳鼻咽喉科手術後に起こる稀な合併症で、重篤な神経学的合併症や死亡に至ることがあります。このような合併症を予防するためには、早期診断と管理を行うために、疑うべき指標が高いことが重要な要素となります。ほとんどの場合、保存的管理が成功し、予後は良好である。
CONCLUSION: Grisel's syndrome is a rare complication that occurs after otolaryngology procedures and can result in serious neurological complications and death. A high index of suspicion is an important factor for early diagnosis and management to prevent such complications. In most cases, conservative management is successful with a good prognosis.
Copyright © 2020 Elsevier B.V. All rights reserved.