What Age Is Grisel’s Syndrome Most Common? A Complete ENT Guide

What age is Grisel syndrome for-various aspects-

By ENT Specialist – Dr. Sagar Rajkuwar, Nashik, Maharashtra, India

Clinic Website: www.entspecialistinnashik.com

Table of contents-

1. Introduction
2. Typical Age Range: Who Gets Grisel’s Syndrome?
3. Why Children Are More Susceptible
4. How Age Influences Presentation and Symptoms
5. Common Age-Related Causes and Triggers
6. Diagnostic Importance of Age Awareness
7. Prognosis and Recovery by Age
8. Conclusion

Introduction

Grisel’s syndrome is a rare but important medical condition that affects the cervical spine (neck), primarily in children. It is characterized by non-traumatic atlantoaxial subluxation, meaning the first two cervical vertebrae (the atlas and the axis) become misaligned without any direct injury or trauma. This occurs due to inflammation and laxity of the ligaments that stabilize these bones, often following an infection or surgical procedure in the head and neck region.

One of the most intriguing aspects of Grisel’s syndrome is its age distribution—it predominantly affects children under 12 years of age, though rare cases have been reported in adolescents and adults. Understanding why this condition is more common in certain age groups requires exploring the anatomy, physiology, and typical triggers involved.

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1. Typical Age Range: Who Gets Grisel’s Syndrome?

Grisel’s syndrome is most commonly seen in children aged 5 to 12 years. However, cases have been reported in:

•  Infants and toddlers as young as 2 years old
•  Adolescents up to 15 years old
•  Adults, though extremely rare

The peak incidence lies in school-aged children (5–10 years). This age range coincides with frequent upper respiratory tract infections, enlarged adenoids, tonsillitis, and ENT procedures—conditions and interventions closely linked with the development of Grisel’s syndrome.

2. Why Children Are More Susceptible

Several anatomical and physiological factors explain why Grisel’s syndrome primarily affects children rather than adults:

a. Ligamentous Laxity

Children naturally have more flexible and elastic ligaments compared to adults. The ligaments that connect the atlas (C1) and axis (C2) vertebrae—the *transverse and alar ligaments*—are not yet fully matured. This makes their cervical spine less stable and more prone to subluxation when inflammation occurs.

b. Rich Vascular Network

The upper neck and throat regions in children have a dense venous plexus that connects the nasopharynx, oropharynx, and cervical spine. When infections like tonsillitis, pharyngitis, or adenoiditis occur, bacteria and inflammatory mediators can easily spread to the atlantoaxial joint, causing inflammation and joint capsule loosening.

c. Frequent ENT Infections

Children are more prone to recurrent infections of the *upper respiratory tract, including the tonsils, adenoids, and sinuses. These infections are the most common triggers of Grisel’s syndrome, either directly or after ENT surgeries such as adenotonsillectomy or mastoidectomy.

d. Underdeveloped Musculature

Neck muscles in children are smaller and weaker than in adults, offering less resistance to joint instability. Thus, even mild ligament inflammation can lead to noticeable subluxation and torticollis (neck tilt).

e. Immature Bone Structure

The bones of the cervical spine are still developing in children. The articulations between the atlas and axis are more mobile, with shallow joint surfaces that make displacement easier when inflammation sets in.

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3. How Age Influences Presentation and Symptoms

The symptoms of Grisel’s syndrome can vary slightly depending on age:

In Younger Children (2–6 years):

•  Often present with *neck stiffness and pain* following a throat infection or fever.
•  Parents may notice the child keeps the head tilted to one side—a condition known as “cock-robin” posture.
•  Crying or irritability on neck movement is common.
•  Younger children may not clearly verbalize pain, so refusal to move the neck may be the only sign.

In Older Children (7–12 years):

•  Complain of neck pain, torticollis, and restricted neck motion.
•  May also experience low-grade fever or sore throat history.
•  Pain is typically worse on turning the head to the affected side.
•  Some children develop mild neurological symptoms (tingling or weakness) if spinal cord irritation occurs.

In Adolescents and Adults:

•  The condition is much rarer but can occur after ENT surgery, trauma, or severe infection.
•  Symptoms are similar but less dramatic, and diagnosis is often delayed because clinicians don’t initially suspect Grisel’s syndrome in older patients.

4. Common Age-Related Causes and Triggers

Grisel’s syndrome often follows:

• Adenoidectomy or tonsillectomy (most frequent surgical causes)
• Upper respiratory tract infections
• Sinusitis, otitis media, or mastoiditis
• Dental or oral infections
• Cervical or skull-base infections

The peak incidence corresponds to the age when adenotonsillar hypertrophy and related surgeries are most common—again, typically 5–12 years.

5. Diagnostic Importance of Age Awareness

Recognizing the typical age group is crucial for early diagnosis. A child between 5 and 12 years old presenting with neck pain and torticollis following a recent throat infection or adenoid surgery should immediately raise suspicion for Grisel’s syndrome.

Diagnostic imaging includes:

• X-ray (open-mouth view)* – may show C1-C2 misalignment.
• CT scan – confirms atlantoaxial subluxation and its extent.
• MRI – detects soft tissue inflammation or ligamentous damage.

Early recognition in the vulnerable age group prevents complications like chronic neck deformity or neurological deficits.

6. Prognosis and Recovery by Age

In children, the prognosis is excellent with early diagnosis and proper treatment:

• Younger children (under 10) respond very well to conservative therapy (antibiotics, anti-inflammatory drugs, and neck immobilization).
• Older children or adolescents may require a longer immobilization period due to stronger neck muscles and firmer bone structures.
• Adults sometimes need surgical stabilization if conservative measures fail.

Permanent complications are rare when treatment begins early, but delayed diagnosis can result in chronic torticollis or spinal cord compression.

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Conclusion

Grisel’s syndrome primarily affects children aged 5 to 12 years, a period marked by frequent throat infections and ENT surgeries. Their unique anatomical and physiological characteristics—such as ligamentous laxity, rich venous connections, and immature bone development—make them more susceptible to cervical spine instability following infection or inflammation.

Early recognition in this age group is vital. With prompt diagnosis, proper neck immobilization, and infection control, most children recover completely without long-term complications. Awareness of the typical age range helps clinicians and parents detect the condition early, ensuring quick and full recovery.

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Clinic address of ENT SPECIALIST doctor Dr Sagar Rajkuwar-

Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik ,422010 ,Maharashtra, India-Dr Sagar Rajkuwar (MS-ENT), Cell no- 7387590194   ,  9892596635

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-FOR INFORMATION IN GREAT DETAIL How Long Does Adenoid Surgery Take? PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL How to Keep Adenoids Healthy Naturally: 12 Expert Tips by an ENT Specialist PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Severe Headache After Adenoidectomy: Normal or Dangerous? PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Is Adenoid Removal Really Risky? What Every Parent Should Know! PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Does Removing Adenoids Improve Hearing? ENT Expert Explains PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Do You Get Sick More Without Adenoids? The Truth by ENT Specialist PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Can Adenoids Cause Ear Pain? ENT Explains Causes, Symptoms & Treatment PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Adenoids Removed but Still Snoring? Here’s What Might Be Going On PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL “Can You Have Enlarged Adenoids Without Enlarged Tonsils? Hidden Causes of Breathing Problems Explained” PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL How Doctors Check Adenoids: Inside the ENT Process Explained Clearly PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL At What Age Are Adenoids Most Active? Every Parent Should Know This! PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Do Adults Have Adenoids? Shocking Truth You Need to Know! PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Is Adenoid Removal Safe in the Long Run? Here’s What You Should Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Can Adenoids Grow Back in Adults? The Truth You Need to Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL How Long Does It Take For Adenoids To Grow Back After Surgery PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL “How Much Does an Adenoid X-Ray Cost? Complete Guide to Prices, Insurance & Tests” PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Is Adenoid Surgery Covered by Insurance? Here’s the Truth You Must Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Cefuroxime and Adenoid Infections: Effective or Not? PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Can Adenoids Cause Low Oxygen Levels? ENT Explains PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Can Enlarged Adenoids Cause Hearing Loss? PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Does Adenoid Removal Really Cause Weight Gain? The Truth Parents Must Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Adenoids and Asthma: Hidden Link Every Parent Must Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL How Many People Have Died from Adenoidectomy? The Truth Parents Must Know PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL When Are the Worst Days After Tonsillectomy and Adenoidectomy? Doctor’s Guide PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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-FOR INFORMATION IN GREAT DETAIL Foods to avoid for adenoids PL CLICK ON THE LINK GIVEN BELOW-It is always better to view links from laptop/desktop rather than mobile phone as they may not be seen from mobile phone.  ,in case of technical difficulties you need to copy paste this link in google search. In case if you are viewing this blog from mobile phone you need to click on the three dots on the right upper corner of your mobile screen and ENABLE DESKTOP VERSION-
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