Mastoiditis with erosion of mandibular condyle

Posted By Wael Nemattalla
Mastoiditis with erosion of mandibular condyle

65 years old male with left sided hearing loss.

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  • Wael Nemattalla 2014-01-28 17:04:00

    The left sigmoid sinus thrombosis is seen extending to left internal jugular vein.



    Acute otomastoiditis is largely a disease of childhood.



    Pathology

    It is most frequently due to bacterial infections, with Streptococcus pneumoniae andHaemophilus influenzae accounting for 65 - 80% of cases.

    H. inf although less common is the more aggressive agent, and more frequently resulting in complications, especially meningitis.

    Usually antibiotics are all that is required for treatment, and imaging is usually not required. When mucoperiosteal involvement evolves into bony involvement, with resorption of bony septae between adjacent mastoid air cells, the condition should be referred to as coalescent mastoiditis (intramastoid empyema) and complications become much more likely.





    Agents

    • Streptococcus pneumoniae : most common

    • Haemophilus influenzae : common and more aggressive than pneumococcus

    • Aspergillus : aggressive, seen in older patients. Frequently associated with facial nerve dysfunction.

    • Tuberculous otomastoiditis : increasing frequency due to greater immunocompromised population.





    Complications

    • subperiosteal abscess (mastoid)

    • labyrinthitis

    • petrous apicitis

    • intracranial extension

    o meningitis

    o subdural empyema

    o cerebral abscess

    o dural sinus occlusive disease (DSOD)

    • facial nerve dysfunction

    • thrombosis of mastoid emissary vein ("Griesinger's sign")







    Chronic otomastoiditis





    Chronic otomastoiditis (COM) should be considered a separate entity from acute otomastoiditis, and is thought to be primarily due to Eustachian tube dysfunction. Interestingly COM is not found in non-human primates. Upright posture and enlarged skull have been postulated as potential predisposing factors.

    The term encompasses a number of conditions:

    • middle ear effusion

    • middle ear granulation tissue

    • cholesterol granuloma

    • middle ear atelectasis - or tympanic membrane retraction

    • acquired cholesteatoma

    • noncholesteatomatous ossicular errosion

    • post inflammatory ossicular fixation

    • tympanic membrane perforation





    source:



    http://radiopaedia.org/articles/acut- e_otomastoiditis

    http://radiopaedia.org/articles/chro- nic_otomastoiditis

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