Traumatic atlantooccipital dislocation with survival

Traumatic atlantooccipital dislocation is generally considered incompatible with life. However, there have been isolated survivals from this injury, and a few patients initially have minimal neurologic deficits disproportionate to the gravity of their injury, a feature that has not been adequately stressed. The potentially catastrophic results of delayed therapy make early radiographic detection imperative. Marked retropharyngeal soft-tissue swelling, an abnormal basion-odontoid alignment, and posterior displacement of the atlas are diagnostic of anterior atlantooccipital dislocation. In the more uncommon posterior atlantooccipital dislocation an abnormal basion-odontoid alignment associated with marked soft-tissue swelling should suggest the correct diagnosis. Conventional tomography can be confirmatory.