Document Detail

The role of the otorhinolaryngologist in the management of central skull base osteomyelitis.
MedLine Citation:
PMID:  17621809     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Skull base osteomyelitis (SBO) typically evolves as a complication of external otitis in diabetic patients and involves the temporal bone. Central SBO (CSBO) mainly involves the sphenoid or occipital bones without coexisting external otitis. We characterized a group of patients with CSBO. The endoscopic nasopharyngeal and clival biopsy technique is described. METHODS: Medical records of patients diagnosed as having SBO were retrospectively analyzed (from 2001 to 2006). Patients' symptoms and signs, laboratory findings, imaging characteristics, endoscopic clival and periclival histopathology results, treatment, and outcome were retrieved. RESULTS: Of 20 patients with SBO, 6 patients without external otitis were studied (age range, 54-76 years; 5 men; mean follow-up, 21 months). All patients suffered from unilateral headache, three of six patients had serous otitis media (SOM), three of six patients had cranial nerve (CN) palsies, and five of six patients had elevated acute-phase reactants. Computed tomography (CT) findings were clival cortical bone erosion and adjacent soft tissue swelling. Magnetic resonance (MR) findings were texture changes and enhancement of the involved bones and soft tissues. Biopsy specimens revealed chronic inflammation. All six patients were treated with antibiotics for 3-6 months. Headache disappeared in five of six patients, SOM resolved in two of three patients, and CN palsies partially recovered in two of three patients. Imaging findings improved in five of six patients. CONCLUSION: CSBO may mimic malignancy and represents a diagnostic challenge. Typical clinical picture and imaging findings together with a positive response to ciprofloxacin may suffice to establish the diagnosis and obviate the need for biopsies. When in doubt, nasopharyngeal and clival biopsies are performed to rule out malignancy.
Oren Cavel; Dan M Fliss; Yoram Segev; Daniel Zik; Avi Khafif; Roee Landsberg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of rhinology     Volume:  21     ISSN:  1050-6586     ISO Abbreviation:  Am J Rhinol     Publication Date:    2007 May-Jun
Date Detail:
Created Date:  2007-07-11     Completed Date:  2007-09-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807268     Medline TA:  Am J Rhinol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  281-5     Citation Subset:  IM    
Departments of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty ofMedicine, Tel-Aviv University, Tel-Aviv, Israel.
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MeSH Terms
Follow-Up Studies
Magnetic Resonance Imaging
Middle Aged
Nasopharynx / pathology
Osteomyelitis / etiology,  pathology*,  radiography
Otitis / complications*
Otorhinolaryngologic Diseases / etiology,  pathology*,  radiography
Retrospective Studies
Skull / pathology*,  radiography
Time Factors
Tomography, X-Ray Computed

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