J Rhinol.  2021 Mar;28(1):57-60. 10.18787/jr.2020.00337.

A Case of Atypical Central Skull Base Osteomyelitis with Bilateral Alveolar Bone Destruction

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Mokdong Hospital, Seoul, Korea
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University, School of Medicine, Seoul Hospital, Seoul, Korea

Abstract

Central skull base osteomyelitis (CSBO) is a rare, fatal condition seen mostly in elderly diabetic or immunocompromised patients; it mainly involves the sphenoid or occipital bones and diagnosis is often delayed. A 72-year-old male with diabetes was referred to our department with severe pain in the maxillary gingiva. Endoscopic biopsy of the pterygoid bone confirmed the presence of mucormycosis combined with Klebsiella pneumoniae infection. Sinus surgery was performed with bilateral alveolar bone sequestrectomy. Long-term intravenous broad-spectrum antibiotic therapy using meropenem and ampicillin/sulbactam and antifungal therapy using amphotericin B (100 mg/day) was administered; an oral antifungal agent, posaconazole (800 mg/day), was also prescribed for 11 weeks. At the 6-month follow-up visit, there were no complications and no progression of the CSBO lesion was observed. Timely diagnosis and multidisciplinary treatment including endoscopic surgery, alveolar bone sequestrectomy, and combined antifungal and antibiotic therapy can reduce mortality and minimize complications associated with CSBO.

Keyword

Skull baseㆍOsteomyelitisㆍMucormycosisㆍMaxillaㆍAlveolar process

Figure

  • Fig. 1. Endoscopic findings. A: Necrotic debris with nasal floor destruction (arrow) was noted in the right nasal cavity. B: Exposed necrotic alveolar bone with gingival dehiscence (arrowhead).

  • Fig. 2. Preoperative paranasal sinus computed tomography (CT) and magnetic resonance images (MRI). A: Axial CT image shows extensive bone destruction (arrows), with gas densities. B: Coronal CT image shows bilateral osteonecrosis of the alveolar bone (arrows). C: Axial T1-weighted image shows pathological contrast enhancement in extensive central skull base (clivus, sphenoid body, right greater wing of sphenoid, right pterygoid process of sphenoid, posterior palatine bone) lesion with bone destruction (arrows). D: Coronal T2-weighted image.

  • Fig. 3. Endoscopy of the right sphenoid (asterisk) showed mild mucosal swelling without necrotic debris, surgical opening extended to pterygoid plate (arrow).


Reference

References

1. Prasad KC, Prasad SC, Mouli N, Agarwal S. Osteomyelitis in the head and neck. Acta Otolaryngol. 2007; 127(2):194–205.
2. Khan MA, Quadri SAQ, Kazmi AS, Kwatra V, Ramachandran A, Gustin A, et al. A Comprehensive Review of Skull Base Osteomyelitis: Diagnostic and Therapeutic Challenges among Various Presentations. Asian J Neurosurg. 2018; 13(4):959–70.
3. Singh A, Al Khabori M, Hyder MJ. Skull base osteomyelitis: diagnostic and therapeutic challenges in atypical presentation. Otolaryngol Head Neck Surg. 2005; 133(1):121–5.
4. Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R. The role of the otorhinolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol. 2007; 21(3):281–5.
5. Sie KC, Glenn MG, Hillel AH, Cummings CW. Osteomyelitis of the skull base, etiology unknown. Otolaryngol Head Neck Surg. 1991; 104(2):252–6.
6. Shama SA. Osteomyelitis of the central skull base: Otogenic and odontogenic sources. Multidetector CT study. The Egyptian Journal of Radiology and Nuclear Medicine. 2012; 43(4):519–26.
7. Adams JR, Bryant DG. Cranial osteomyelitis: a late complication of a dental infection. British Journal of Oral and Maxillofacial Surgery. 2008; 46(8):673–4.
8. Sokołowski J, Lachowska M, Karchier E, Bartoszewicz R, Niemczyk K. Skull base osteomyelitis: factors implicating clinical outcome. Acta Neurol Belg. 2019; 119(3):431–7.
9. Medvedev G, Palacios E, Jones W. Iatrogenic occipital osteomyelitis. Ear Nose Throat J. 2009; 88(1):720–1.
10. Adams JR, Bryant DG. Cranial osteomyelitis: a late complication of a dental infection. Br J Oral Maxillofac Surg. 2008; 46(8):673–4.
11. Clayman GL, Adams GL, Paugh DR, Koopmann CF Jr. Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope. 1991; 101(3):234–9.
12. Johnson AK, Batra PS. Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 2014; 124(5):1083–7.
13. Blyth CC, Gomes L, Sorrell TC, da Cruz M, Sud A, Chen SC. Skull-base osteomyelitis: fungal vs. bacterial infection. Clin Microbiol Infect. 2011; 17(2):306–11.
Full Text Links
  • JR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr