Türk Nöroşirürji Dergisi 2003 , Vol 13 , Num 3
Feyza KARAGÖZ GÜZEY1, Erhan EMEL1, Selma SÖNMEZ ERGUN2, N. Serdar BAŞ1
1SSK Vakıf Gureba Eğitim Hastanesi, Nöroşirürji Kliniği, İstanbul
2SSK Vakıf Gureba Eğitim Hastanesi, Plastik ve Rekonstrüktif Cerrahi Kliniği, İstanbul
Objective: To report a case with chronic skull base osteomyelitis due to malign external otitis going on about forty years with exacerbations and remissions.

Methods and results: Seventy-one-year-old man was attended with complaints of right facial palsy and an ulceration and flux in front of right ear for a few years. It was learned that he had complained of ear ache, flux form right ear and diminished hear. Eritrocyte sedimentation rate and blood leucocyte count were high. In computed tomography and magnetic resonance imaging, there was a soft tissue mass affecting temporobasal bone, temporomandibular joint and head of mandibula and causing dural thickness. In the patient, the differential diagnosis between malignancy and infection could not be performed. Extensive surgical resection was performed and the skin defect was closed by scalp rotation flap. In pathologic examination, chronic infection findings were shown. After long-standing antibiotic therapy, eritrocyte sedimentation rate and leucocyte count were diminished. The patient made a good recovery, but facial palsy remained unchanged.

Conclusions: Chronic skull base osteomyelitis remains a difficult problem both in diagnosis and treatment, and it may be misdiagnosed as malignancy, especially in older patients. Although it is a curable disease, early diagnosis and treatment is essential if complications such as facial palsy is not to be wished. Maintaining a high index of suspicion is important in making a proper diagnosis for this rare disease. Anahtar Kelimeler : Cranial nerves, osteomyelitis, skull base