PMC7331757_01
Initial (A) and 12-month (B) open-mouth radiographs in a boy with a lateral and rotatory atlantoaxial subluxation. There was narrowing of the atlantoaxial joints (black arrows), lateral displacement of the C2 with respect to the overhang of C1 lateral mass (white arrow), and asymmetry of the lateral atlantodental intervals, indicating rotatory displacement of the atlantoaxial joint.
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Open-mouth odontoid radiograph (Figure 1A) revealed unequal spacing of lateral atlantodental intervals and the C1 lateral masses, consistent with atlantoaxial rotatory subluxation. At posttreatment surveillance, the patient was asymptomatic with nearly full cervical ROM, despite persistent radiographic evidence of C1C2 instability (Figure 1B).
Seven months after symptom onset of atlantoaxial subluxation. Axial (A) and reconstructed (B) CT images displayed eccentric positioning of the dens at C1 level. Coronal slice (C) showed cartilaginous structures in both the apical and the subdental synchondroses. Small spur formation noted. Sagittal slice (D) demonstrated a gap in the dens in addition to the cartilaginous structures remained in the ossification centers (white arrows). The pediatric patterns of the vertebral structure placed the atlantoaxial joint at a significant risk of instability.
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Computed tomography of the neck (Figure 2) displayed eccentric positioning of the dens at C1 level, and evidences of incomplete ossification of the synchondroses.
Head position and neck rotation after treatment were restored in a 10-year-old boy with chronic atlantoaxial subluxation. Temporary gynecomastia is usually physiological in preteen boys and an unrelated finding to atlantoaxial subluxation. However, sulfation is a principal catabolic pathway of sex hormones. Long-term acetaminophen use can increase the bioavailability of estradiol by decreasing estradiol sulfation. Much of these relationships, as in this case, remain unconfirmed.
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Bilateral gynecomastia was incidentally discovered, with no pain or complaints (Figure 3).