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Arquivos Internacionais de Otorrinolaringologia 2012; 16(01): 130-134
DOI: 10.7162/S1809-48722012000100020
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Clinical and tomography evolution of frontal osteomyelitis: Case report

Evolução clínica e tomográfica da osteomielite frontal: Relato de caso
Raquel Crisóstomo Lima Verde
1   Otorhinolarynghology Resident Physician of Professor Egdar Santos University Hospital - UFBA.
,
Luana Alves de Souza
1   Otorhinolarynghology Resident Physician of Professor Egdar Santos University Hospital - UFBA.
,
Bruno Farias Lessa
1   Otorhinolarynghology Resident Physician of Professor Egdar Santos University Hospital - UFBA.
,
Clara Mônica Figueiredo de Lima
2   Otorhinolaryngologist Doctor. Rhinology Fellow of Otorhinolarygology Department of Professor Egdar Santos University Hospital - UFBA.
,
Marcus Miranda Lessa
3   Otorhinolaryngology PhD of FMUSP. Adjunct Professor of Otorhinolarynghology Department of Professor Edgard Santos University Hospital - UFBA.
,
Hélio Andrade Lessa
4   Otorhinolarynghology PhD by UFBA. Otorhinolarynghology Department Chief of Professor Edgard Santos University Hospital.
› Author Affiliations
Further Information

Publication History

02 February 2010

18 July 2010

Publication Date:
12 February 2014 (online)

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Summary

Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration.

Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia.

Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease.

Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Resumo

Introdução: A osteomielite frontal é uma complicação de rinossinusite que pode ter evolução aguda ou crônica. Há reação inflamatória com aumento da pressão intra-óssea, isquemia e necrose local, levando à formação de abscesso ósseo. Não havendo drenagem, ocorrerá descolamento do periósteo, invasão de partes moles e piora da isquemia com posterior sequestro ósseo.

Método: Relato de caso de um paciente internado em serviço de emergência de outra instituição por complicação de rinossinusite que foi encaminhado para o Serviço de Otorrinolaringologia do Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia.

Relato de Caso: Paciente masculino, 16 anos, apresentou-se ao serviço de emergência de outra instituição com cefaleia, vômitos e febre que evoluiu com edema periorbitário e frontal à esquerda, cursando com flutuação palpebral e frontal.Submetido à drenagem de abscesso palpebral e frontal, com antibioticoterapia de amplo espectro sem melhora. Encaminhado para o nosso serviço mantendo edema e flutuação em região frontal e edema leve em região periorbitária esquerda. A endoscopia nasal evidenciou edema em meato médio à esquerda e a tomografia computadorizada mostrou sinusite fronto-etmoidal à esquerda e sinais de osteomielite frontal com sequestro ósseo e empiema epidural.Submetido à cirurgia endoscópica nasossinusal, acesso externo para exérese do osso frontal acometido e drenagem do empiema epidural. Evoluiu com remissão da doença.

Considerações Finais: A falência no diagnóstico e no tratamento das complicações da rinossinusite pode levar a sequelas e complicações fatais.O diagnóstico de osteomielite frontal é firmado pela suspeita clinica e confirmado por exames radiológicos.A cirurgia está indicada quando a evolução for insidiosa, havendo sequestro ósseo ou complicações intracranianas.

Keywords

osteomyelitis - frontal sinusitis - tomography - evolution

Palavras-chave

osteomielite - sinusite frontal - tomografia - evolução
 

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