Torticollis, Facial Asymmetry, Local Pain, and Barré‐Liéou Syndrome in Connection with One‐Sided Ponticulus Posticus: A Case Report and Review of the Literature

Background Ponticulus posticus (PP) occurs frequently and may cause symptom series, including vertebrobasilar insufficiency, migraine, hearing loss, and Barré‐Liéou syndrome. However, few studies to date have described surgical treatment of PP. We report a rare case of a patient who suffered from torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with PP. We also review the pertinent literature, focusing on surgical treatment for symptoms due to PP. Case presentation A 23‐year‐old male presented with the chief complaint of continuous significant dizziness to the point of losing consciousness while rotating his head to the right. Plain radiographs and computed tomography (CT) scans of the cervical spine showed a С1 anomaly with the formation of complete PP on the left (dominant) side, with acute‐angled, С‐shaped kinking of the vertebral artery. Resection of PP via the posterior midline was performed successfully. The patient had satisfactory postoperative relief from localized pain and Barré‐Liéou syndrome, but there were no obvious changes in the torticollis and facial asymmetry observed during the 3‐month follow‐up period. Conclusions This case is a rare presentation of torticollis, facial asymmetry, localized pain, and Barré‐Liéou syndrome in connection with one‐sided complete PP. This tetrad indicates that PP may affect the patient earlier than expected. In such situations, early diagnosis and timely surgical treatment may significantly improve patients' quality of life and avoid the development of torticollis and face asymmetry. The significant aspect of the presented clinical case was the patient suffered from torticollis, facial asymmetry, local pain, and Barre‐Lieou syndrome caused by a ponticulus posticus, which is an anomalous bony bridge of the atlas. The patient had satisfactory relief of symptoms after surgery, except for torticollis and facial asymmetry.