ABSTRACT
Introduction: Grisel syndrome is a rare condition of rotator subluxation of the atlantoaxial joint that is not associated with trauma or bone lesion. It is characterized by acute and painful torticollis with fever, which is a consequence of complicated pharyngitis and tonsillitis. Material(s) and Method(s): We present two girls, aged 5 and 6 years, who developed atlantoaxial subluxation and torticollis during or after infection with COVID. As part of this, a pararetropharyngeal abscess developed. Based on clinical signs, radiological findings, and the course of the disease, Grisel's syndrome was confirmed. One patient had an asymptomatic COVID infection, before the development of Grisel's syndrome, and the other patient had an active COVID infection, during which Grisel's syndrome developed. Result(s): Both patients were treated multidisciplinary: conservatively with antibiotics and surgically, and then physical therapy was introduced along with the Philadelphia orthosis. Both were in constant clinical improvement and did not develop further complications. According to the literature, the Fielding-Hawkins classification describes 4 degrees of this subluxation, and our patients had type 3 at the time of diagnosis. Conclusion(s): Grisel's syndrome is a rare condition and should be suspected in children with painful torticollis after infections or head and neck surgery. The importance of this syndrome for maxillofacial surgeons is in early differential diagnosis, to avoid early and late consequences of undiagnosed pararetropharyngeal abscess and atlantoaxial subluxation and compression of vital structures. Grisel's syndrome needs to be treated multidisciplinary and immediately.
ABSTRACT
Introduction: Dermal hyaluronic fillers are considered one of the most common minimally invasive procedures in aesthetic surgery. In the last three years, the human population has been significantly affected by the viral disease COVID-19, from which 559 million people have fallen ill and 6.36 million have died worldwide. A new, rare but significant side effect of the COVID-19 disease or a consequence of vaccination against COVID is a delayed inflammatory reaction in the area where dermal fillers were applied. Material(s) and Method(s): We present the case of two patients who developed a delayed inflammatory reaction in the area of the applied filler two and four months after the application of hyaluronic fillers for lip augmentation, and after recovering from COVID and receiving the vaccine against COVID. In both patients, the reaction was manifested by localized edema. Localized infection and the possibility of an allergic reaction to the preparation are excluded. Result(s): After the oral therapy was applied (antihistamines and pulse therapy with corticosteroids) within 24 hours, there was an improvement in the findings and a local regression of the inflammatory reaction. Conclusion(s): A literature review revealed several described cases of delayed inflammatory reaction after a COVID-19 infection or vaccination against COVID, and this side effect is still not often seen in clinical practice. The reaction between the hyaluronic acid filler and the SarsCoV-2 virus is believed to be immune-mediated. Since patients often initially contact the doctor who applied the filler, it is necessary to take into account information about past infection or vaccination in the anamnestic before administering the filler, and to take the delayed inflammatory reaction into account in the differential diagnosis. It is important to recognize this complication in time, to prevent more severe complications in time.