Osteomyelitis of the skull base and the cervical vertebrae. A case report and literature review

Abstract

Introduction: Skull base and neck osteomyelitis are rare but very dangerous infections. Usually it complicates persistent otitis externa. Diagnosis and therapeutic management are very difficult especially because of the complexity of the anatomical region. Instability of the head neck junction after osteomyelitis is not commonly reported. Presentation case: We report a case of a 35-year-old man who presented a skull base and cervical vertebrae osteomyelitis initiated by otitis externa. Adapted antibiotherapy led to clinical and biological improvement. Follow up imaging demonstrated an important instability of the head-neck junction. Surgery fixation was indicated and the patient had an instrumented occipital-neck arthrodesis. Follow-up showed a good clinical situation, no infection recurrence and reparative bone changes. Discussion: Bone lesions and the infiltration of the soft tissue could bring up the fear of a latent malignant process. The biopsy piece have always to be sent to microbiology as well as histology examination. Surgical arthrodesis wasn't commonly reported in literature but was indicated in our case, after total healing, because the instability of the head-neck junction. Conclusion: Skull base and cervical vertebrae osteomyelitis is a severe disease. Early diagnosis and appropriate antibiotherapy are desirable to offer the better chances for healing and to prevent potential complications. The indication of surgical arthrodesis was appropriate regarding the clinical and radiological result, but further supervision is necessary given the risk of infection recurrence. Keywords: Osteomyelitis, Skull base, Cervical vertebrae, Otitis externa