[Treatment of bone infection in the area of the skull]

Osteomyelitis in the skull region is encountered preferably as a postoperative, but also as a posttraumatic lesion, furthermore it occurs in case of infection of the paranasal sinuses or, rarely, as hematogenic metastasis. The routine treatment comprises a careful wound cleaning with excision of fistula, resection of the osteomyelitic bone and ablation of all purulent and devital tissues, eventually sanitation of an infected paranasal sinus. Between six and twelve months after the healing of the infection, the bone defect is closed by plastic surgery. In 1976, we have introduced Refobacin-Palacos R for the local treatment of the infection with simultaneous definitive closing of the bone defect in case of osteomyelitis of the skull. 44 patients have been treated since with this method. The rate of reinfection was 3% in osteomyelitis of the calotte without involvement of the sinuses and 25% in case of involvement of the frontal sinuses. A twofold method has been developed in order to reduce the relatively high frequency of reinfection in case of involvement of the frontal sinuses. The wound cleaning with revision of the frontal sinuses and parenteral administration of antibiotic drugs was performed as usual. An additional local treatment of the infected frontal sinuses was performed by implantation of Septopal chains which were removed ten to fourteen days later. During the same session the nasal excretory ducts were closed and the frontal sinuses largely filled up with muscle pieces together with a compound of spongiosa, fibrin, and antibiotic. The remaining bone gap was closed with Refobacin-Palacos R. A significantly decreased reinfection rate is anticipated with this twofold procedure, however, a clear statement is not yet possible due to the small number of cases and the relatively short follow-up period.