Grisel's Syndrome

The lymphatic drainages of the upper cervical joints are primarily into the retropharyngeal lymphatic nodes and then into the deep cervical chain. These nodes also drain the paranasal sinuses, the nasopharynx and retropharyngeal area. As a result, a retrograde inflammatory change may affect the synovial lining of the craniocervical joint complex with resultant effusion and instability, even neurological deficit. This has been referred to as “Grisel’s syndrome”.

    It was shown that (by Parke et al.) pharyngovertebral veins may have frequent lymphovenous anastomosis. The periodontal venous plexus in the suboccipital epidural sinuses appears to have a direct communication with the pharyngovertebral veins. This may result in osteomyelitis of the craniocervical joints due to infection in the paravertebral region. Thus, there is an added route for septic involvement of the craniocervical junction.

Grisel P (1930) Enucleation des l’atlas et torticollis nasopharyngien. Presse Med 38:50
ParkeWW, Rothman RH, BrownMD (1984) The pharyngovertebral veins. An anatomical rationale for Grisel’s syndrome. J Bone Jt Surg Am 66:568

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