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Central condylar displacement with brain abscess from chronic mandibular osteomyelitis
Thomas Lee1, Ross Green, Jack Hsu
1Department of Otolaryngology, Upstate Medical University, Syracuse, New York, USA.
The Laryngoscope
|January 15, 2013
Summary
Undiagnosed mandibular osteomyelitis caused a rare complication, leading to a temporal lobe abscess and facial nerve palsy. Surgical intervention and antibiotics successfully resolved the infection and restored facial nerve function.
Area of Science:
- Otolaryngology
- Neurosurgery
- Oral and Maxillofacial Surgery
Background:
- Undiagnosed mandibular osteomyelitis can lead to severe, long-term complications.
- Chronic odontogenic infections may result in fistulas and cranial nerve involvement.
Observation:
- A 53-year-old female presented with altered mental status, facial nerve palsy (House-Brackmann V), and condylar head dislocation into the middle cranial fossa.
- Imaging revealed chronic mandibular osteomyelitis with glenoid fossa erosion, middle cranial fossa penetration, and a temporal lobe abscess.
Findings:
- Surgical management involved a combined middle cranial fossa and intraoral approach for partial mandibulectomy and condylectomy.
- Postoperative treatment with meropenem for 6 weeks led to complete resolution of skull base osteomyelitis and the parotid fistula.
Implications:
- This case highlights the importance of recognizing rare complications of mandibular osteomyelitis.
- Prompt diagnosis and aggressive surgical and antibiotic treatment can achieve full recovery from severe neurological deficits and infections.
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