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Transmastoid and Transtemporal Drainage of Petrous Apicitis with Otitis Media
Heba Isaac1, Andrew Liu1, Seiji B Shibata1
1Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Background:
Petrous apicitis (PA) is a serious infection involving the apical portion of the petrous temporal bone. The classic triad of purulent otorrhea, ipsilateral abducens nerve palsy and retroorbital pain is rarely seen due to early detection and widespread use of antibiotics. Medical management is the primary treatment modality with surgery reserved for cases of recalcitrant petrous apex abscess.
Methods And Results:
We presented a case of PA with previously untreated otitis media. After multidisciplinary evaluation, the patient was initially treated with intravenous antibiotics followed by drainage of the abscess using a combined transmastoid and middle cranial fossa (MCF) approach. The patient recovered well with no recurrence of the infection based on imaging and symptoms.
Discussion:
While a variety of different surgical approaches can be used in treatment of PA, we recommend the MCF approach in cases where access to the anterior petrous apex may be challenging via transcanal or transmastoid approach.
Insights
Petrous apicitis (PA), a rare temporal bone infection, requires prompt treatment. A combined transmastoid and middle cranial fossa approach effectively drained a petrous apex abscess, leading to successful patient recovery.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Petrous apicitis (PA) is a severe infection of the petrous temporal bone apex.
- Classic symptoms are infrequent due to early diagnosis and antibiotic use.
- Medical management is primary; surgery is for refractory petrous apex abscesses.
