Grisel’s Syndrome Treatment: Expert ENT Guide to Recovery and Management

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

Clinic Website: www.entspecialistinnashik.com

Table of contents-

• 1)Introduction
• 2)What is Grisel’s Syndrome?
• 3)Causes and Risk Factors
• 4)Following a tonsillectomy or adenoidectomy
• 5)Grisel’s Syndrome Symptoms
• 6)Grissel’s syndrome diagnosis
• 7)Managing Grisel’s Syndrome
• 8)Popular Surgical Treatments
• 9)Outlook and Rehabilitation
• 10)Problems If Not Treated
• 11)Avoiding Grisel’s Syndrome
• 12)When to Consult an ENT Expert
• 13)Summary

1)Introduction

Although uncommon, Grisel’s syndrome is a significant disease that is frequently overlooked in its early stages. It entails a partial dislocation between the first and second cervical vertebrae (C1 and C2) in the form of nontraumatic atlantoaxial subluxation. In children, this condition is frequently brought on by infections or inflammation in the head and neck area.

Despite its complexity, timely diagnosis and appropriate treatment can result in a full cure in the majority of cases, eliminating the need for surgery. The etiology, symptoms, therapy, and different management strategies for Grisel’s syndrome, including conservative and surgical alternatives, will be covered in this article.

2)What is Grisel’s Syndrome?

A uncommon inflammatory illness called Grisel’s syndrome causes rotation and partial dislocation of the atlantoaxial joint, which is the connection between the first two cervical vertebrae. The term non-traumatic subluxation refers to the fact that this kind of dislocation happens spontaneously, in contrast to traumatic dislocations.
Due to the increased ligamentous laxity and the proximity of ENT infections to the upper cervical spine, it mostly affects children between the ages of 5 and 12.

3)Causes and Risk Factors

The most frequent underlying cause of Grisel’s syndrome is inflammation or infection in the nasopharyngeal, oropharyngeal, or cervical area. A few common causes are:

• URTIs, or upper respiratory tract infections
• Tonsillitis or adenoiditis
• Sinus Infection
• Middle ear infection (otitis media)
• Pharyngitis

4)Following a tonsillectomy or adenoidectomy

dental operations or surgery after the nose

Inflammation and relaxation of the ligaments that support the atlantoaxial joint can result from the transmission of infection from the pharynx to the cervical spine through the pharyngovertebral veins. This leads to partial dislocation and a typical neck abnormality.

DISCLAIMER-Some patients go to net and directly take treatment from there which can lead to catastrophic consequences-Then- Many people ask then why to read all this text -the reason is that it helps you to understand the pathology better ,you can cooperate with treatment better ,your treating physician is already busy with his patients and he does not have sufficient time to explain you all the things right from ABCD ,so it is always better to have some knowledge of the disease /disorder you are suffering from.

5)Grisel’s Syndrome Symptoms

Early recognition of the symptoms is essential to avoid neurological issues. Some of the most frequent signs and symptoms are:

• Neck discomfort and rigidity
• tortikollis (head tilting to one side)
• Restricted neck mobility
• A fever
• Current or recent history of ear or throat infection
• Throat pain or trouble swallowing
• A youngster may sometimes experience a headache or be irritable.

Spinal cord compression might result in neurological symptoms like limb weakness or numbness in severe or neglected cases, necessitating prompt medical intervention.

6)Grissel’s syndrome diagnosis

Early diagnosis is crucial for preventing complications and guaranteeing a full recovery. The following examinations are often carried out by orthopedic and ENT experts:

1. Physical Examination
The first clues include a thorough physical examination that reveals torticollis and a comprehensive medical history that includes current infections or surgery.

2. Radiological Imaging
X-ray (open-mouth perspective) – Could reveal misalignment or rotation of C1 and C2.
cervical spine CT scan – The preferred diagnostic imaging is that which offers a thorough visual representation of the atlantoaxial subluxation.
MRI scan Aids in evaluating any spinal cord compression, ligament involvement, and soft tissue inflammation.

7)Managing Grisel’s Syndrome

The stage of the disease, the severity of the subluxation, and the presence of neurological symptoms all influence the course of treatment.
Conservative therapy is frequently adequate and quite successful in the majority of cases that are diagnosed early.

1. Treatment that is Conservative (Non-surgical)

This is the initial step of treatment, which focuses on minimizing inflammation, addressing subluxation, and easing muscle spasms.

Rest and Immobilization
The patient should be confined to bed rest and have their neck immobilized by either a hard or soft cervical collar.
Immobilization for two to three weeks may be enough in minor cases.
Cervical traction or halo traction may be employed in more severe cases for progressive treatment.

B. Medications
Antibiotics: Broad-spectrum antibiotics are prescribed to eradicate infections, such as sinusitis, adenoiditis, and pharyngitis.
Anti-inflammatory medications (NSAIDs): To lessen pain and inflammation.
Muscle relaxers: Aid in reducing neck spasms and increasing mobility.
Pain relievers: For comfort and pain management.

C. Physiotherapy
Mild physiotherapy and range-of-motion exercises are initiated to fortify neck muscles and avoid stiffness after the discomfort and inflammation have subsided.
Don’t use forceful manipulation, as it could make the subluxation worse.

D. Treatment of the Primary Cause
Treating the underlying problem is necessary if Grisel’s syndrome has occurred as a result of inflammation following an ENT infection or surgery:
Tonsillitis or adenoiditis: appropriate antibiotic treatment and monitoring.
Inflammation after surgery: proper wound care, infection management, and sufficient rest.

2. Surgery

Surgery is only taken into consideration when conservative therapy is unsuccessful in treating persistent, recurring, or neurologically complex situations.

When Surgery Is Necessary
After 4–6 weeks of conservative treatment, it fails.
Continual atlantoaxial instability
Neurological impairment brought about by cord compression
Repeated subluxation in spite of immobilization

8)Popular Surgical Treatments

A. Atlantoaxial Fusion
A surgical procedure in which screws or bone transplants are used to fuse the C1 and C2 vertebrae in order to provide a permanent joint stabilization.
This guarantees long-term stability by preventing additional rotation.

B. Open Reduction and Fixation
Performed in cases of significant displacement or when closed reduction fails.
Under anesthesia, the surgeon physically realigns the joint and keeps it in place.

C. Posterior Cervical Fusion
Used in cases of severe ligament injury or instability affecting numerous cervical levels.
After surgery, the patient is immobilized with a halo vest or cervical collar, and a rigorous rehabilitation program is implemented.

9)Outlook and Rehabilitation

If caught and treated early, the prognosis for Grisel’s syndrome is typically quite good. The majority of kids make a full recovery without experiencing any neurological impairment.
Timeline for Recovery:

• Moderate cases: conservative treatment for 2 to 4 weeks
• Moderate cases: physiotherapy and traction for 4–6 weeks
• Severe cases (post-surgical): 8–12 weeks of rehabilitation and immobilization

Nonetheless, chronic neck malformation or neurological consequences might result from cases that are ignored or have a delayed diagnosis.

10)Problems If Not Treated

Grise’s syndrome can have severe effects if not treated in a timely manner, such as:

• Neck deformity that is permanent (fixed torticollis)
• Atlantoaxial instability
• spinal cord compression
• Quadriplegia (in rare circumstances)
• limited range of motion and ongoing discomfort
• Early identification and rapid ENT or orthopedic assessment are therefore essential.

11)Avoiding Grisel’s Syndrome

Although it cannot always be avoided, there are actions that can lower the risk:

• Treat ENT infections right away: Never disregard serious ear infections, sore throats, or sinus infections in children.
• Appropriate post-surgical care: Make sure to get enough rest and prevent infection after a tonsillectomy, adenoidectomy, or ear operation.
• Avoid any unexpected neck movements or trauma while recovering from an infection: Protect your neck.
• Follow-up regularly: particularly following ENT operations or persistent infections.

Unique Considerations for Children with Grisel’s Syndrome
Because of their smaller bones and larger ligamentous laxity, children are more susceptible. The treatment of children should be conservative unless problems occur.
Utilize traction techniques and soft cervical collars that are appropriate for the child’s size.
Once the neck is stable, promote mild physiotherapy.
Regular imaging follow-ups to verify correction.
Teach parents how to keep their necks safe and spot any signs of recurrence.

12)When to Consult an ENT Expert

If you see any of the following, see an orthopedic surgeon or an ENT professional:

• constant head tilt following a throat infection or surgery
• Child exhibiting neck discomfort, stiffness, or restricted range of motion
• Any neurological signs, such as numbness, weakness, or imbalance
• Early intervention prevents surgery and ensures a speedy recovery.

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13)Summary

Although uncommon, Grisel’s syndrome may be treated and reversed if caught early. After an ENT infection or surgery, the key is to recognize symptoms like torticollis and seek medical attention right away.

Most patients respond well to conservative treatment, which includes antibiotics, immobilization, and physical therapy. Only severe or persistent situations are treated surgically.
Patients can make a full recovery and resume their regular activities without any lasting issues if they get a prompt diagnosis and professional ENT treatment.

If any patient has any ENT -Ear nose throat problems and requires any , consultation ,online consultation ,or surgery in clinic of  ENT specialist Doctor Dr Sagar Rajkuwar ,he may TAKE APPOINTMENT BY CLICKING ON THE LINK GIVEN BELOW-

www.entspecialistinnashik.com 

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 Adenoids vs. Allergies: What Doctors Want You to Understand 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 Are Adenoid Problems Genetic? What Every Parent Needs to Know About Family Risk 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 Food Get Stuck in Your Adenoids? ENT Explains the Hidden Truth” 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 Adenoids Affect the Brain? Hidden Impacts 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 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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