Cranial osteomyelitis: a late complication of a dental infection

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British Journal of Oral and Maxillofacial Surgery 46 (2008) 673–674

Short communication

Cranial osteomyelitis: a late complication of a dental infection James R. Adams ∗ , Douglas G. Bryant Department Oral and Maxillofacial Surgery, James Cook University Hospital, Marton Road, Middlesborough, Teeside, TSS 4BW, United Kingdom Accepted 15 March 2008 Available online 19 May 2008

Abstract Dental infections are associated with a range of serious complications. The orofacial region provides potential spaces in the tissue that infections of dental origin can occupy. We describe the subtemporal extension of a dental infection, the late development of cranial osteomyelitis, and its surgical management. © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Keywords: Subtemporal abscess; Cranial osteomyelitis

Case report A healthy 55-year-old woman who had had a painful upper left second molar extracted because of a dental abscess presented to hospital three weeks later with a painful swollen left temple, fever, and intermittent photophobia. Five days after the extraction she had had left temporal pain, tenderness, and trismus, which had progressed over the next two weeks. A computed tomogram (CT) showed a large, left subtemporal abscess (Fig. 1). Radiographic features showed that infection had spread along the deep surface of temporalis. It responded to incision and drainage, and two weeks of cephalosporin and metronidazole. The microbiological culture was polymicrobial, and heavy in both anaerobic Gram-negative bacilli and Gram-positive cocci. Bacteroides fragilis (consistent with an extension from a dental infection) was isolated as the dominant growth. Her initial recovery was good, but at three months she had new pain and tenderness at the surgical site. CT showed left cranial osteomyelitis (Fig. 2). She had a left parietal craniectomy. Bacterial cultures from the bony spec-

imen were polymicrobial. Gram-positive cocci and bacillus spp were dominant so she was given rifampicin and cefradine for four weeks. She made a full recovery and awaits reconstruction.

∗

Corresponding author. Tel.: +44 0796 6022254. E-mail addresses: [email protected] (J.R. Adams), [email protected] (D.G. Bryant).

Fig. 1. Computed tomogram showing left subtemporal abscess.

0266-4356/$ – see front matter © 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.bjoms.2008.03.025

674

J.R. Adams, D.G. Bryant / British Journal of Oral and Maxillofacial Surgery 46 (2008) 673–674

Pain and tenderness in the temporal region warrants early investigation. Evidence of coexisting dental disease or recent dental treatment should be investigated as a rare but potential source of infection.1 The subsequent development of parietal osteomyelitis with a dental origin has been reported previously,2 and although rare, should be recognised as a potentially serious complication of dental infection.

References 1. Diacono MS, Wass AR. Infratemporal and temporal fossa abscess complicating dental extraction. J Accid Emerg Med 1998;15: 59–61. 2. Calayatud-Perez V, Trull Gimbernat JM, Gonz´alezs Lagunas J. Parietal osteomyelitis of dental origin: a case report. J Craniomaxillofac Surg 1993;21:127–9.

Fig. 2. Computed tomogram showing left cranial osteomyelitis.