{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:01:50Z","timestamp":1780470110946,"version":"3.54.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Grisel syndrome (GS), also referred to as nontraumatic atlantoaxial subluxation, is typically associated with head and neck infections, inflammation, or postoperative complications. Its clinical manifestations include torticollis, neck pain and stiffness, restricted cervical mobility, and muscle spasms. Based on the pathological features of GS following tonsillectomy and adenoidectomy, as well as the anatomical relationship between the palatine tonsils and the atlantoaxial joint, this report proposes a therapeutic approach combining manual stimulation of the tonsillar reflex zone with a four-step atlantoaxial manipulative reduction for the management of this condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 7-year-old Chinese boy presented with neck pain, cervical deviation, and restricted range of motion persisting for over two weeks. The patient demonstrated marked limitation in left cervical rotation, with mild restrictions in right rotation, flexion, and extension. Based on the patient's clinical presentation, the primary therapeutic intervention consisted of manual stimulation of the tonsillar reflex zone combined with an atlantoaxial manipulative reduction protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After nine days of treatment, the patient demonstrated resolution of cervical pain with improvement in cervical flexion, extension, and rotational movements. Tonsillar region discomfort had also significantly resolved. At the 15-day follow-up assessment, both cervical alignment and functional mobility were restored to normal physiological parameters, with no recurrence of tonsillar or cervical pain reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This clinical case demonstrates that manual stimulation of the tonsillar region can alleviate local inflammation, while combined with cervical soft tissue relaxation and atlas-axis joint reduction to restore normal anatomical alignment. This integrated protocol successfully achieved therapeutic goals for this condition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1744987","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:05:20Z","timestamp":1780466720000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined tonsillar reflex zone stimulation and four-step manipulative reduction for Grisel syndrome following pediatric adenotonsillectomy: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Yiding","family":"Zhao","sequence":"first","affiliation":[{"name":"College of Acupuncture, Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Acupuncture, Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Tuina, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"271","DOI":"10.16295\/j.cnki.0257-358x.2023.03.013","article-title":"Clinical study on four-step manipulative reduction combined with tendon-regulating manipulation and intermittent traction in treatment of atlanto-axial subluxation","volume":"42","author":"Ren","year":"2023","journal-title":"Shandong J Tradit Chin Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"228","DOI":"10.3969\/j.issn.1672-6731.2017.03.012","article-title":"Study on the causes and mechanism of atlantoaxial dislocation","volume":"17","author":"Liu","year":"2017","journal-title":"Chin J Contemp Neurol Neurosurg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"110225","DOI":"10.1016\/j.ijporl.2020.110225","article-title":"Grisel\u2019s syndrome post otolaryngology procedures: a systematic review","volume":"137","author":"Al-Driweesh","year":"2020","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1212\/WNL.0000000000200023","article-title":"Pearls & oy-sters: grisel syndrome presenting as pseudodystonia: a twist in the neck","volume":"98","author":"KP","year":"2022","journal-title":"Neurology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1177\/014556130408300814","article-title":"Grisel\u2019s syndrome: the two-hit hypothesis\u2013a case report and literature review","volume":"83","author":"Battiata","year":"2004","journal-title":"Ear Nose Throat J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"295","DOI":"10.7507\/1002-0179.202412226","article-title":"Progress in the diagnosis and treatment of grisel\u2019s syndrome after adenotonsillectomy","volume":"40","author":"Xue","year":"2025","journal-title":"West China Med J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e62028","DOI":"10.7759\/cureus.62028","article-title":"Grisel\u2019s syndrome after COVID-19 in a pediatric patient: a case report","volume":"16","author":"Hashimoto","year":"2024","journal-title":"Cureus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.13201\/j.issn.1001-1781.2017.22.004","article-title":"Complications analysis of adenoidectomy and tonsillectomy assisted with ablation on children","volume":"31","author":"Sun","year":"2017","journal-title":"J Clin Otorhinolaryngol Head Neck Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00590-025-04505-z","article-title":"Imaging characteristics, surgical efficacy and treatment strategies for type IIIa atlantoaxial rotatory dislocation: a retrospective comparative study with type III","volume":"35","author":"Wu","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2106\/00004623-197759010-00005","article-title":"Atlanto-axial rotatory fixation. 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