Infection in the head and neck area spreads toward
the upper cervical vertebrae. The inflammation causes laxity of the
atlantoaxial ligament complex, leading to anterior subluxation of the atlas
on the axis. This probably follows rupture of the transverse ligament and
may result in spinal cord compression. The cause of infection may be (1)
postsurgery: mastoidectomy, tonsillectomy, adenoidectomy, removal of tumors, or
choanal atresia repair, (2) contiguous infection: rhinopharyngitis, tonsillitis, abscess
(retropharyngeal to alveolar), or ear infections, or (3) other more rare associations, such as acute
rheumatic fever or inflammatory bowel disease.