Osteomyelitis is a severe inflammation within the bone, bone marrow and surrounding soft tissue, that develops secondary to infection with microbial organisms. Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Perspective of individual bones components apertures transmitted structures 3. Skull base osteomyelitis in the emergency department. The terms osteomyelitis of the temporal bone, skull base osteomyelitis and malignant otitis externa have not been clearly defined, and have in the past often been used interchangeably in the. Sep 25, 2015 the aim of this study is to describe the clinical presentation of central skull base osteomyelitis and to discuss the classical imaging findings and various diagnostic and therapeutic challenges faced in the management of this condition. It affects predominantly diabetic and immunocompromised males and has a high mortality rate. Osteomyelitis of the skull base neurosurgery oxford. Osteomyelitis of the bones of the skull resulting from an infection in the accessory sinuses of the nose is not uncommon and has been known a long time, but tilley1 was the first to note such a relationship. Extensive enhancement of the skull base, with associated soft tissue, involvement of the right zygomatic arch and the pterygoid muscles on the right. The condition was first described by chandler in 1968. Bilateral skull base osteomyelitis in an immunocompetent.
Although bone is normally resistant to bacterial colonization, events such as trauma, surgery, presence of foreign bodies, or prostheses may disrupt bony integrity and lead to the onset of bone infection. The typical clinical scenario involves a diabetic or immunodeficient patient with otitis externa that was either inadequately treated or refractory to standard antibiotic therapy. The initial inflammation has now eroded the tegmen tympani inflaming the dural lining, eroded the j. Any information contained in this pdf file is automatically generated. There are many disease processes involving clivus, that are mixed due to their histological origin bone. Osteomyelitis of the bones of the skull resulting from an infection in the accessory sinuses of the nose is not uncommon and has been known a long time, but tilley 1 was the first to note such a relationship. Successful treatment might also involve specialists from other departments, such as general surgery, vascular surgery and plastic surgery. Osteomyelitis is inflammation of the bone caused by an infecting organism. Severe skull base osteomyelitis caused by pseudomonas. Skull base osteomyelitis caused by an elegant fungus.
Rhinocerebral mucor infection is characteristically an acute, fulminant, and deadly infection also affecting the orbits and deep face and. Osteomyelitis of the base of the skull secondary to aspergillus. Antonella cinquegrani, concetta alafaci, ketty galletta, santi racchiusa, francesco salpietro, marcello longo, giovanni grasso, francesca granata. Acute osteomy elitis often results in rapid lytic destruction of the skull base bone commonly associated with cranial nerve palsyparalysis, and rarely, with.
Skull base osteomyelitis presenting as villarets syndrome kuolun huang1 and chinsong lu1, 2 abstractthis report documents a 47yearold male who developed acute deficits of the ix, x, xi, xii cranial nerves and horners symptoms, consistent with villarets syndrome. Skull base osteomyelitis presenting as villarets syndrome kuolun huang1 and chinsong lu1, 2 abstractthis report documents a 47yearold male who developed acute deficits of the ix, x, xi, xii cranial nerves and horners symptoms, consistent with. Inadequate or partial treatment was responsible for gradual progression of disease to the skull base. The long standing left middle ear mastoid inflammation can lead to a multitude of complications, the severe one being skull base osteomyelitis. Fungal skull base osteomyelitis causing hearing loss and cranial nerve palsies in a man with. Central skull base osteomyelitis in patients without. The infection causes damage in the region around the ear and skull base. Osteomyelitis medical conditions rush rush university.
Skull base osteomyelitis sbo is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. Skull based osteomyelitis is an infection of the bone or bone marrow, typically caused by bacteria or sometimes fungus. Skull fractures hard blows to the cranium result in fractures that usually radiate out from the site of impact in rather straight lines. Diagnosis of skull base infections sbi is a clinical and radiological dilemma. Ivan james keogh at school of medicine national university of ireland, galway ivan james. The intention of this study was to evaluate contemporary trends in etiology, diagnosis, management, and outcome of sbo and to draw the clinicians attention on this probably underestimated disease. Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. This is a small series of 3 cases of skull base osteomyelitis that show atypical onset and evolution. Osteomyelitis of the skull base is a rare occurrence. Common symptoms are localized bone pain and tenderness with constitutional symptoms in acute osteomyelitis or without constitutional symptoms in chronic osteomyelitis.
In such cases of masked skull base osteomyelitis, there is considerable difficulty in establishing an early diagnosis. Diagnosis and management of osteomyelitis of osteomyelitis. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Case report a case of skull base osteomyelitis with. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Malignant otitis externa associated with skull base osteomyelitis is a rare but life threatening condition. Skull base osteomyelitis presenting as villarets syndrome. Central skull base osteomyelitis csbo represents a lifethreatening complication of external ear canal infection. The routes of infection spread in central skull base osteomyelitis. Osteomyelitis is inflammation and destruction of bone caused by bacteria, mycobacteria, or fungi. To download the pdf, click the download link above.
Imaging of mucormycosis skull base osteomyelitis american. This disease is difficult to diagnose and manage, although advances have been seen with antibiotics and hyperbaric oxygen. The basic approach for chronic osteomyeli tis treatment should be surgery, and prognosis depends on surgical debridement. What is the abbreviation for skull base osteomyelitis. Pseudomonas aeruginosa is the most common causative organism. Posttraumatic chronic cranial osteomyelitis due to a superficial wound a clinical and neuroradiological case. Computed tomography ct and magnetic resonance imaging mri play key roles in assessment of csbo progression. Posttraumatic chronic cranial osteomyelitis due to a. Distinguishing between fungal and bacterial aetiologies of sbo has significant. Skull base osteomyelitis is an uncommon disease that usually complicates a malignant external otitis with temporal bone involvement. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including nobel prize winners and some of the worlds mostcited researchers. Recently, complications have arisen due to the emergence of atypical osteomyelitis. There are variety of names for this condition, including necrotizing external otitis, and malignant otitis externa. In total, 62 scans 30 cts and 32 mris were performed to evaluate the extent of inflammatory.
Osteomyelitis musculoskeletal and connective tissue. In such cases of masked skull base osteomyelitis, there is. In total, 62 scans 30 cts and 32 mris were performed to evaluate the extent of. May 01, 2011 malignant otitis externa associated with skull base osteomyelitis is a rare but life threatening condition. Luc2 reported a case at a meeting of the british medical association in 1897, and since that. Pdf skull base osteomyelitis is a rare and frequently difficult condition to diagnose. Osteomyelitis is an infection of bone that can occur in any age group. Central skull base osteomyelitis sbo is a lifethreatening disease originating from ear and from sinonasal infections. The temporomandibular joint on the right side is also involved.
These syndromes have distinct characteristics, yet they may progress to involve similar structures, resulting in inflammation and invasion of the adjacent internal carotid artery ica. Skull base osteomyelitis sbo is an uncommon but lifethreatening condition caused by invasive bacterial or fungal infection. Of the 84 cases, 24 required a cranial vault, 20 cases of frontal bone osteomyelitis involved chronic sinusitis, and 4 cases of temporal bone. Article information, pdf download for skull base osteomyelitis. Ear disorders skull based osteomyelitis california ear. Typical osteomyelitis is reportedly caused by pseudomonous aeruginosa in elderly diabetic patients after malignant external otitis. Treatment of osteomyelitis can include antibiotics, splinting, or surgery. This study was prospective study and was designed for cases of otogenic and odontogenic sources of central skull base osteomyelitis. The greatest challenge, however, remains in differentiating skull base osteomyelitis from skull base malignancy. Pulling, md, maine medical center, portland, maine o steomyelitis is generally categorized as acute or chronic based on histopathologic find. Antonella cinquegrani, concetta alafaci, ketty galletta, santi racchiusa, francesco salpietro, marcello longo, giovanni grasso, francesca granata posttraumatic chronic cranial osteomyelitis due to a superficial wound a clinical and neuroradiological case report.
To reconstruct the known microsurgical anatomical triangles on. Despite this, the disease has a significant mortality and morbidity rate. We have experiensed 5 cases of skull base osteomyelitis at our hospital. Sbo generally arises from ear infections and infrequently complicates sinonasal infection. Central skullbase osteomyelitis csbo represents a lifethreatening complication of external ear canal infection. The four cases presented, which were drawn from the oxford, united kingdom, skull base pathology database, had a diagnosis of central skull base osteomyelitis.
Read atypical culturenegative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma, american journal of otolaryngology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Normal skull base concept of fossa does not work well for the skull base, because the bony anatomy spills over from one fossa to the next. Luc 2 reported a case at a meeting of the british medical association in 1897, and since that time many valuable contributions have been made. Twelve patients with csbo were included in a retrospective clinical study. The routes of infection spread in central skull base. Otolaryngology head and neck surgeryvolume 3, issue 1, july 2005. Optic nerve involvement from pseudomonas aeruginosa. Skull base syndromes associated with thrombophlebitis of. The aim of this study is to describe the clinical presentation of central skull base osteomyelitis and to discuss the classical imaging findings and various diagnostic and therapeutic challenges faced in the management of this condition. Ct and mri findings in skull base osteomyelitis a pictorial essay poster no c0955 congress.
Read osteomyelitis of the base of the skull secondary to aspergillus, american journal of otolaryngology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. To document diagnostic and management difficulties inmasked skull base osteomyelitis secondary to malignant otitisexterna, emphasis on establishing. Help us write another book on this subject and reach those readers. References to any names, marks, products, or services of third parties or hypertext links to third.
Atypical skull base osteomyelitis arising from the sphenoid or occipital bones without associated external otitis occurs much less frequently and initially may have headache as the only symptom. Skull base osteomyelitis involving clivus due to tb is. Here we present a case that emerged with multiple infarctions in the right cerebrum. The clivus is a hidden part of the base of the skull located between the foramen magnum and back of the sella and so far difficult to explore. At times, skull base osteomyelitis follows the partial antibiotic treatment of mastoiditis, a paranasal sinus. Rhinocerebral mucor infection is characteristically an acute, fulminant, and deadly infection also affecting the orbits and deep face and is. The osteomyelitis of the medial portion of the central skull base that mostly complicates invasive fungal sinusitis was excluded from this study. Skull base osteomyelitis sbo is an infection of the bone or bone marrow, typically caused by bacteria or sometimes fungus. Skull base syndromes associated with thrombophlebitis of the. Involvement of the cn ixxii and postganglionic sympathetic fibers figure 12 site of lesion is the retropharynx where these structures are close in proximity cn vii is classically the most common cranial nerve involved, at the stylomastoid foramen. These bacteria are responsible for causing damage in the region around the ear and skull base. Skull base osteomyelitis caused by an elegant fungus sharafine stephen1, beula subashini2, regi thomas 3, ajay philip4, rajan sundaresan5 abstract malignant otitis externa skull base osteomyelitis is predominantly caused by bacteria while fungal etiology is rare.
Osteomyelitis of the skull base neurosurgery oxford academic. Malignant otitis externa with skull base osteomyelitis. Atypical skull base osteomyelitis in the intensive care unit. Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. Pdf ct and mri findings in skull base osteomyelitis a. Inclusion criteria were cases of skull base bony infection, as suggested by radiological, histological, and microbiological findings, where there was no immediate temporal relationship to a case of otitis externa. To understand the concept of ideal lskull base tumor surgeon friendly imaging protocol. Sbo abbreviation stands for skull base osteomyelitis. Bilateral skull base osteomyelitis in an immunocompetent patient introduction skull base osteomyelitis is a relatively uncommon medical condition. Alternatively, you can download the pdf file directly to your computer, from where it can be opened using a pdf reader.
A severe blow, such as from a hammer or a bullet, may cause a depressed fracture in which several pieces of skull detach inwards to be driven into the brain and these will require surgical elevation. Pulling, md, maine medical center, portland, maine o steomyelitis is generally categorized as. May 01, 2016 read atypical culturenegative skull base osteomyelitis masquerading as advanced nasopharyngeal carcinoma, american journal of otolaryngology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The skull the skull the skull the skull anatomy of the skull mesenchymoma of the skull osteomyelitis of the skull the skull in mongolism fracture of the skull. These specialists are readily available and skilled at collaborating. Chronic osteomyelitis of skull associated with necrotic. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Atypical skull base osteomyelitis in the intensive care.
To depict identify the key anatomic landmarks on ct and mri skull base data sets for the surgeon to decide and plan his surgical approach for skull base tumors. Typically, the inflammation of the skull base results from infection from neighboring. Rhinosinusitis, malignant otitis externa, and skull base osteomyelitis represent a spectrum of cranial invasive fungal disease ifd. Most cases of osteomyelitis of the skull base occur as a result of inadequately treated. This is a retrospective analysis of inpatient case records, carried out in a multidisciplinary tertiary care hospital. Skull base osteomyelitis sbo is typically bacterial in origin and caused by pseudomonas, although the fungus aspergillus has also rarely been implicated. Causes of osteomyelitis include bacteria in the bloodstream from infectious diseases that spread to the bone, an open wound from a trauma over a bone, and recent surgery or injection in or around a bone. Skull base osteomyelitis ie, malignant otitis externa is a severe osteogenic infection usually observed in elderly patients with diabetes mellitus or patients who are immunocompromised. Diagnostic and therapeutic challenges among various presentations.
This is a temporary file and hence do not link it from a website, instead link the url of this page if you wish to link the pdf file. Thickening and enhancement of the adjacent dura and cranial nerve enhancement should raise suspicion of skull base osteomyelitis. A 5yearold child presented to the emergency department with a threeweek history of fever associated with drowsiness and left parietal headache, and a weeks history of swelling on the left frontoparietal soft tissue. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis.