Lesson of the Week: Don't twist my child's head off: iatrogenic cervical dislocation

Excessive rotation of two children's necks while they were undergoing cervical lymph node biopsy probably resulted in their dislocation; delayed diagnosis necessitated complex spinal surgery to correct the deformity. “Wry” neck, a synonym for atlantoaxial rotary subluxation, is a relatively common condition in young children often associated with tonsillitis. It usually resolves spontaneously,1 because the joint surfaces remain in contact. A rotation injury is another possible cause, often following an apparently minor trauma such as heading a football. Iatrogenic torticollis is rarely reported. A complete dislocation of the atlantoaxial joint will not resolve spontaneously and may have important long term effects on the child's facial development. We have treated two otherwise normal children whose necks were dislocated under general anaesthesia while they were undergoing cervical lymph node biopsy. The injury was not appreciated at once and definitive treatment was inevitably delayed.