Skull Base 2009; 19(4): 247-254
DOI: 10.1055/s-0028-1115325

© Thieme Medical Publishers

Central or Atypical Skull Base Osteomyelitis: Diagnosis and Treatment

Matthew P.A Clark1 , 3 , Pieter M. Pretorius2 , 3 , Ivor Byren4 , Chris A. Milford1 , 3
  • 1ENT Department, Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • 2Neuroradiology Department, Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • 3The West Wing John Radcliffe Hospital, Nuffield Orthopaedic Centre, Oxford, United Kingdom
  • 4Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
Further Information

Publication History

Publication Date:
09 January 2009 (online)


Objective: We report cases of central or atypical skull base osteomyelitis and review issues related to the diagnosis and treatment. Methods: The four cases presented, which were drawn from the Oxford, United Kingdom, skull base pathology database, had a diagnosis of central skull base osteomyelitis. Results: Four cases are presented in which central skull base osteomyelitis was diagnosed. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. They presented with headache and a variety of cranial neuropathies. Imaging demonstrated bone destruction, and subsequent microbiological analysis diagnosed infection and prompted prolonged antibiotic treatment. Conclusion: We concluded that in the diabetic or immunocompromised patient, a scenario of headache, cranial neuropathy, and bony destruction on imaging should raise the possibility of skull base osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause.


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Matthew P.A ClarkF.R.C.S. 

(ORL-HNS) Specialist Registrar, ENT Department, The West Wing John Radcliffe Hospital Headley Way

Oxford, OX3 9DU 01865 741 166