Semin Plast Surg 2009; 23(2): 073-079
DOI: 10.1055/s-0029-1214159
© Thieme Medical Publishers

Osteomyelitis of the Craniofacial Skeleton

David J. Pincus1 , Milton B. Armstrong1 , Seth R. Thaller1
  • 1Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine, Miami, Florida
Further Information

Publication History

Publication Date:
30 April 2009 (online)


Skull-based osteomyelitis, which is a true bony infection, originates from a chronic, inadequately treated infection. Because of the complex craniofacial skeletal anatomy and associated aesthetic concerns, osteomyelitis of the craniofacial skeleton must be uniquely managed and is more difficult to treat than osteomyelitis of other bones of the body. It is thought that osteomyelitis is decreasing in prevalence due to broad-spectrum antibiotic treatment; however, it still remains a challenging clinical entity in developing countries and lower socioeconomic areas.


  • 1 Prasad K C, Prasad S C, Mouli N, Agarwal S. Osteomyelitis in the head and neck.  Acta Otolaryngol. 2007;  127 194-205
  • 2 Flemming H. Osteomyelits of the skull.  California and Western Medicine. 1925;  XXIII 985-988
  • 3 Osteomyelitis. In: Peterson L Contemporary Oral Maxillofacial Surgery. 4th ed. Philadelphia,PA; Mosby Publishers 2003: 375-377
  • 4 Strumas N, Antonyshyn O, Caldwell C B, Mainprize J. Multimodality imaging for precise localization of craniofacial osteomyelitis.  J Craniofac Surg. 2003;  14 215-219
  • 5 Wallace-Hudson J. Osteomyelitis and osteoradionecrosis. In: Fonseca RJ Oral and Maxillofacial Surgery: Surgical Pathology. Philadelphia, PA; WB Saunders 2000: 484-490
  • 6 Tuon F F, Russo R, Nicodemo A C. Brain Abscess Secondary to Frontal Osteomyelitis. Revista do Instituto de Medicina Tropical de Sao Paulo. 2006 http://Available at: Accessed August 27, 2007
  • 7 Naeem A et al.. Fungal osteomyelitis of the skull base.  Infect Med. 2003;  20 535
  • 8 Cierny G, Mader J T, Penninck J J. A clinical staging system for osteomyelitis.  Clin Orthop Relat Res. 2003;  414 7-24
  • 9 Parsons B, Strauss E. Surgical management of chronic osteomyelitis.  Am J Surg. 2004;  188 57-66
  • 10 Rowlands R G, Lekakis G K, Hinton A E. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy.  J Laryngol Otol. 2002;  116 556-558
  • 11 Ng J, Connolly D J, Rittey C D, Mordekar S R. Skull base osteomyelitis leading to lateral meduallry syndrome in a child.  Eur J Paediatr Neurol. 2007;  11 111-114
  • 12 Subburaman N, Chaurasia M K. Skull base osteomyelitis interpreted as malignancy.  J Laryngol Otol. 1999;  113 775-778
  • 13 Chang P C, Fischbein N J, Holliday R A. Central skull base osteomyelitis in patients without otitis externa: imaging findings.  AJNR Am J Neuroradiol. 2003;  24 1310-1316
  • 14 Singh A, Al Khabori M, Hyder M J. Skull base osteomyelitis: diagnositic and therapeutic challenges in atypical presentation.  Otolaryngol Head Neck Surg. 2005;  133 121-125
  • 15 Heggie A A, Shand J M, Aldred M J, Talacko A A. Juvenile mandibular chronic osteomyelitis: a distinct clinical entity.  Int J Oral Maxillofac Surg. 2003;  32 459-468
  • 16 Varvares M A, Lin D, Hadlock T et al.. Success of multiple, sequential, free tissue transfers to the head and neck.  Laryngoscope. 2005;  115 101-104
  • 17 Gbara A, Darwich K, Li L, Schmelzle R, Blake F. Long term results of jaw reconstruction with microsurgical fibula grafts and dental implants.  J Oral Maxillofac Surg. 2007;  65 1005-1009
  • 18 Valentini V, Cassoni A, Marianetti T M et al.. Reconstruction of craniofacial bony defects using autogenous bone grafts: a retrospective study on 233 patients.  J Craniofac Surg. 2007;  18 953-958
  • 19 Tan O, Atik B, Ergen D. Temporal flap variations for craniofacial reconstruction.  Plast Reconstr Surg. 2007;  119 152e-163e
  • 20 Schusterman M A, Reece G P, Kroll S S, Weldon M E. Use of the AO plate for immediate mandibular reconstruction in cancer patients.  Plast Reconstr Surg. 1991;  88 588-593
  • 21 Schusterman M A, Reece G P, Miller M J. Osseous free flaps for orbit and midface reconstruction.  Am J Surg. 1993;  166 341-345

David J PincusM.D. 

Research Fellow, Division of Plastic and Reconstructive Surgery, University of Miami School of Medicine

3019 Holtz Center - JMH East Tower, 1611 N.W. 12th Avenue, Miami, FL 33136