Gradenigo's syndrome (GS) is a rare entity characterized by otitis media, pain in the trigeminal nerve distribution and abducens nerve palsy. The classic triad is uncommon, making the diagnostic workup challenging. Specifically, the diagnostic approach includes medical history, a complete otorhinolaryngological examination, a pure-tone audiogram and radiological investigation such as contrast-enhanced computed tomography scan and magnetic resonance imaging of head and neck. Broad-spectrum antibiotics are the first-line treatment, such as intravenous (IV) ceftriaxone and IV metronidazole. Here, we present the case of a 71-year-old man with a previous history of otitis media and poorly controlled type 2 diabetes mellitus. He presented to our attention with facial pain, left hemilarynx paralysis, dysphagia and otorrhea. The patient was treated with broad-spectrum antibiotics without any clinical improvement. Imaging evaluations demonstrated the presence of wide and poorly defined pathological material with epicenter in the masticatory space, involving all nearby structures. The patient underwent multiple biopsies without obtaining a defininerve palsy.

Mammarella, F., Loperfido, A., Velletrani, G., Casorati, F., Stasolla, A., Di Girolamo, S., et al. (2024). Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo’s Syndrome: Early Dysphagia and Late Abducens Nerve Palsy. JOURNAL OF MEDICAL CASES, 15(2-3), 43-48 [10.14740/jmc4191].

Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo’s Syndrome: Early Dysphagia and Late Abducens Nerve Palsy

Velletrani G.;Di Girolamo S.;
2024-01-01

Abstract

Gradenigo's syndrome (GS) is a rare entity characterized by otitis media, pain in the trigeminal nerve distribution and abducens nerve palsy. The classic triad is uncommon, making the diagnostic workup challenging. Specifically, the diagnostic approach includes medical history, a complete otorhinolaryngological examination, a pure-tone audiogram and radiological investigation such as contrast-enhanced computed tomography scan and magnetic resonance imaging of head and neck. Broad-spectrum antibiotics are the first-line treatment, such as intravenous (IV) ceftriaxone and IV metronidazole. Here, we present the case of a 71-year-old man with a previous history of otitis media and poorly controlled type 2 diabetes mellitus. He presented to our attention with facial pain, left hemilarynx paralysis, dysphagia and otorrhea. The patient was treated with broad-spectrum antibiotics without any clinical improvement. Imaging evaluations demonstrated the presence of wide and poorly defined pathological material with epicenter in the masticatory space, involving all nearby structures. The patient underwent multiple biopsies without obtaining a defininerve palsy.
2024
Pubblicato
Rilevanza internazionale
Articolo
Comitato scientifico
Settore MEDS-18/A - Otorinolaringoiatria
English
Con Impact Factor ISI
Gradenigo's syndrome
Abducens nerve palsy
Otitis media
Skull base osteomyelitis
Mammarella, F., Loperfido, A., Velletrani, G., Casorati, F., Stasolla, A., Di Girolamo, S., et al. (2024). Refractory Pseudomonas Osteomyelitis of the Skull Base With Gradenigo’s Syndrome: Early Dysphagia and Late Abducens Nerve Palsy. JOURNAL OF MEDICAL CASES, 15(2-3), 43-48 [10.14740/jmc4191].
Mammarella, F; Loperfido, A; Velletrani, G; Casorati, F; Stasolla, A; Di Girolamo, S; Bellocchi, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/395690
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