Beyond Gradenigo syndrome: Facial palsy and cavernous sinus involvement in a young teenage girl

Abstract

While complications from acute otitis media have decreased dramatically with the introduction of antibiotics, they still occur and can be associated with severe adverse outcomes. We hereby present a 10-year-old girl who developed left facial nerve and abducens nerve weakness following inadequate management of an acute otitis media infection. In 1904, Giuseppe Gradenigo first described the clinical triad of otorrhea from suppurative acute otitis media, unilateral pain in the region innervated by the trigeminal nerve branches V1 and V2, and ipsilateral abducens nerve weakness. In addition to Gradenigo syndrome, our patient had facial nerve weakness as well as internal carotid artery compression caused by a suspected cavernous sinus thrombosis. A multidisciplinary team approach was crucial to managing her condition until full recovery. The controversy of anticoagulation therapy and surgical treatment are discussed.

Keywords

• Facial palsy
• Gradenigo syndrome
• Cavernous sinus thrombosis
• Complicated mastoiditis
• Acute otitis media