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Atlantoaxial Rotatory Dislocation with Hypoglossal Nerve Palsy in a Patient with Ankylosing SpondylitisA Case Report
Jui-Teng Chien, MD1; Ing-Ho Chen, MD2; Kun-Huei Lin, MD1
1 Department of Orthopedics, Buddhist Tzuchi Dalin General Hospital, 2, Min-Sheng Road, Dalin Town, Chiayi 622, Taiwan. E-mail address for J.-T. Chien: jtchien@mail2000.com.tw
2 Department of Orthopedics, Buddhist Tzuchi Medical Center, 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan
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Investigation performed at the Department of Orthopedics, Buddhist Tzuchi Dalin General Hospital, Chiayi, Taiwan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1587-1590. doi: 10.2106/JBJS.D.02667
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Atlantoaxial subluxation is a rare but well-recognized complication of ankylosing spondylitis1-7. Anterior subluxation is most common, but vertical subluxation of the dens may also occur and may result in cervical myelopathy, lower cranial nerve palsy, or even sudden death due to cervicomedullary compression8-10. Tongue paralysis due to isolated hypoglossal nerve palsy is also rare11-13. In addition to occurring in patients with rheumatoid arthritis14,15, hypoglossal nerve palsy has been noted in association with a number of pathological conditions such as occipital condylar fracture, metastatic tumor in the skull base, and infection16. We report on a patient with ankylosing spondylitis who presented with life-threatening atlantoaxial rotatory dislocation and bilateral hypoglossal nerve palsy and was successfully treated with halo-dependent traction followed by occipitocervical arthrodesis. To the best of our knowledge, bilateral hypoglossal nerve palsy with tongue paralysis arising from atlantoaxial rotatory dislocation has never been reported in a patient with ankylosing spondylitis. The patient consented to have the data concerning the case submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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