Early-adult-onset osteomyelitis of the frontal bone and Bioverit^® bone substitute-based reconstruction

Osteomyelitis of the skull in young adults is a rare, polymorphous, potentially devastating disease. Classic variants include endogenous spread of acute or chronic sinusitis and exogenous infection following trauma.

A 19-year old woman presented with a progressive, dull frontal headache, accompanied by swelling of the left forehead. Apart from a minor trauma of the left forehead she had nothing else of note in her medical history. MRI and CT showed an anterior and posterior table-arroding space-occupying lesion of the left frontal sinus. Endoscopy showed signs of chronic frontal sinusitis. We proceeded towards functional endoscopic sinus surgery including infundibulotomy. Osteomyelitis of the anterior table of the frontal sinus was detected after surgical exploration. Based on this finding we performed an ablation of the anterior table of the frontal sinus. Histology confirmed the macroscopic suspicion but also revealed post-traumatic changes. Implantation of the 3D-based Bioverit^® bone substitute was successful after wound healing and a course of antibiotic treatment.

In conclusion, this report describes a combined exogenously and endogenously induced osteomyelits of the frontal bone and sinus with an invasive, non-neoplastic space-occupying lesion in the absence of detectable pathogens. We attribute the forehead swelling seen here to an incipient "Pott´s puffy tumor", a rare but typical complication of frontal bone osteomyelitis. Owing to the successful ablation with no subsequent disease activity, we decided against additional antibiotic treatment. Reconstructive surgery of the anterior table achieved a pleasing cosmetic result.

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Artikel online veröffentlicht:
10. Juni 2020