Rotary atlanto-axial subluxation with torticollis following central-venouscatheter insertion

Atlanto-axial subluxation with torticollis is an uncommon condition that oc curs in children usually as a result of pharyngeal infection, minor trauma, or neck surgery. Passive motion of the head and neck during general anesth esia is probably another etiologic factor. Torticollis is the most common p resenting physical finding. Pain may or may not be present, but is commonly present with passive neck motion. Neurologic sequelae are uncommon. Our ca se illustrates this condition as a complication of central venous catheter (CVC) insertion in a child under general anesthesia. The surgeon should sus pect this pathology when a child presents with torticollis following CVC pl acement. Precautions should be taken in the operating room to avoid aggress ive rotation and extension of the child's neck while under general anesthes ia whether or not cervical inflammation is present. Special attention to he ad and neck positioning should be taken in patients with Down's syndrome si nce they are at increased risk for atlanto-axial subluxation. The prognosis is excellent when diagnosed early. A delay in diagnosis can result in the need for surgical intervention.