Abstract: Objective To review the potential causes of atlantoaxial subluxation(AARS)after adenoidectomy in children, and to summarise experience in diagnosis and management to prevent its occurrence. Methods The clinical data of six cases of AARS patients who underwent nasal endoscopic low-temperature plasma adenoidectomy and(or)tonsillectomy in our hospital from January 2014 to December 2023 were retrospectively reviewed. Their clinical manifestations, radiological findings, blood test results, and treatment approaches were analysed. Results All ARRS patients presented with neck pain, limited neck mobility and fever within 2-7 days postoperatively, without any neurological symptoms. Some patients had torticollis and cervical spine tenderness. All patients underwent radiological examination of the atlantoaxial joint in the open-mouth positive position and in the lateral position with X-ray or CT scan, showing a variance of the bilateral lateral atlanto-dental space(VBLADI)>2.2 mm and an atlanto-dental interval(ADI)<3.0 mm belonging to the Fielding-Hawkins I type. All patients had a postoperative infection, with five cases of bacterial infection and a case of viral infection. All patients received antibiotic treatment, cervical collar, and(or)cervical traction, which were effective in curing AARS. Conclusion If patients have neck pain, limited neck mobility, fever, etc. after adenoidectomy, it should be considered as cervical lymphadenitis or AARS. Radiological examination of the atlantoaxial joint in the open-mouth positive position and in the lateral position by X-ray or CT scan may help to differentiate the diagnosis. A CT scan of the cervical spine can better classify AARS. Once AARS is diagnosed and classified as Fielding-Hawkins type I, early conservative treatment such as antibiotic treatment, cervical collar and(or)cervical traction should be given as soon as possible to prevent neurological sequelae.

Key words: Adenoidectomy, Tonsillectomy, Atlantoaxial subluxation, Grisel syndrome, Infection