Giuseppe Gradenigo: Much more than a syndrome! Historical vignette

Matis, Georgios; Silva, Danilo O. de A.; Chrysou, Olga I.; Karanikas, Michael; Birbilis, Theodossios

doi:10.4103/2152-7806.102343

Cited by 11 publications

(11 citation statements)

References 13 publications

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“…5 Gradenigo's syndrome was first described by Guiseppe Gradenigo in 1904. 6 Since decades incidences have seen a decline due to era of broad spectrum antibiotics as well health awareness programmes like ENT diagnostic camps. 7 Clinical symptoms was the criteria to start with medical management.…”

Section: Introductionmentioning

confidence: 99%

Gradenigo’s syndrome: a petrous apex lesion

Kale¹,

Gaikwad²,

Chhabria³

2020

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">Unsafe chronic suppurative otitis media (CSOM) requires early attention, otherwise leads to various extracranial and intracranial complications. Petrositis is one of the complications of temporal bone due to unsafe CSOM leading to inflammation or abscess in the petrous apex along with involvement cranial nerves V and VI nerve and leading to a trio of symptoms like ipsilateral otorrhea, deep facial pain and ipsilateral lateral rectus palsy, this clinical trio collectively called as Gradenigo’s syndrome. We have done retrospective study of 3 cases who were presented to our tertiary care centre ENT-OPD with symptoms suggestive of Gradenigo’s syndrome. Cases selected by simple random sampling. Cases with ear malignancy was excluded from study. Cases were followed up for 3 months and results were analysed. Petrositis if ignored can lead to rare but fatal complication of unsafe CSOM. Common in males in third decade and the ear swab suggestive of common organism was pseudomonas. Medical management given as per culture and sensitivity report of ear swab and then followed by definitive surgery of canal wall down tympano-mastoidectomy with petrous apex decompression.</p>

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Section: Introductionmentioning

confidence: 99%

Gradenigo’s syndrome: a petrous apex lesion

Kale¹,

Gaikwad²,

Chhabria³

2020

Int J Otorhinolaryngol Head Neck Surg

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“…Gradenigo’s syndrome was first described in 1904 by Guiseppe Gradenigo [ 1 ]. This syndrome involves a triad of symptoms consisting of diplopia due to palsy of the sixth (abducens) cranial nerve, unilateral periorbital pain due to involvement of the fifth (trigeminal) cranial nerve, and persistent otorrhea due to bacterial otitis media with involvement of the apex of the petrous part of the temporal bone, petrous apicitis (apical petrositis).…”

Section: Introductionmentioning

confidence: 99%

Gradenigo’s Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis

2017

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Patient: Male, 58Final Diagnosis: Bacterial meningitisSymptoms: Altered mental status • headache • neck stiffness • vomitingMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Gradenigo’s syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve. Gradenigo’s syndrome is rare, and the diagnosis is easily overlooked. This case is the first to report Gradenigo’s syndrome presenting with meningitis on a background of chronic suppurative otitis media (CSOM) and petrous apicitis (apical petrositis).Case Report:A 58-year-old male African American presented with headaches and confusion. Magnetic resonance imaging (MRI) of the head showed petrous apicitis with mastoiditis and abscess formation in the cerebellomedullary cistern (cisterna magna). The case was complicated by the development of palsy of the fourth (trochlear) cranial nerve, fifth (trigeminal) cranial nerve, and sixth (abducens) cranial nerve, with radiological changes indicating infection involving the seventh (facial) cranial nerve, and eighth (vestibulocochlear) cranial nerve. Cerebrospinal fluid (CSF) culture results were positive for Klebsiella pneumoniae, sensitive to ceftriaxone. The patient improved with surgery that included a left mastoidectomy and debridement of the petrous apex, followed by a ten-week course of antibiotics. Follow-up MRI showed resolution of the infection.Conclusions:This report is of an atypical case of Gradenigo’s syndrome. It is important to recognize that the classical triad of Gradenigo’s syndrome, suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve, may also involve chronic suppurative otitis media (CSOM), which may lead to involvement of other cranial nerves, petrous apicitis (apical petrositis), and bacterial meningitis.

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“…Within a year, he earned a position in Turin's Polyclinic as the head of the Department of Otolaryngology, where he created additional clinics for the poor and developed an otolaryngology training program. 12,42,52 In 1891, along with several of his peers, Gradenigo initiated the Italian Society of Laryngology, Otology, and Rhinology. 12,42,51,52 In 1896 he was promoted to the position of Professor of Otology in Turin.…”

Section: Giuseppe Gradenigo (1859-1926)mentioning

confidence: 99%

“…12,42,52 In 1891, along with several of his peers, Gradenigo initiated the Italian Society of Laryngology, Otology, and Rhinology. 12,42,51,52 In 1896 he was promoted to the position of Professor of Otology in Turin. It was in the following years that Gradenigo studied a range of subjects, including audiology, but the topic he paid special attention to was otitis media.…”

Section: Giuseppe Gradenigo (1859-1926)mentioning

confidence: 99%

“…3) was a renowned figure in the Italian otological community of the late 19th and early 20th centuries; he was known throughout the world for his work on "Gradenigo's syndrome," a triad of symptoms that accompanies petrous apicitis, and his extensive leadership and authority in the developing field of otolaryngology. 12,20,42,51,52 Gradenigo was born on September 29, 1859, in Venice, Italy, to a family of respected and influential Venetians. After completing his medical training at the University of Padua in 1877, Gradenigo moved to Vienna to work with his mentor, Adam Politzer, the legendary father of European otology.…”

Section: Giuseppe Gradenigo (1859-1926)mentioning

confidence: 99%

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Gruber, Gradenigo, Dorello, and Vail: key personalities in the historical evolution and modern-day understanding of Dorello’s canal

Reddy¹,

Reddy²,

Jyung

et al. 2016

JNS

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A century ago an ambitious young anatomist in Rome, Primo Dorello, who sought to understand the cause of abducent nerve palsy that often occurred in patients with severe middle ear infections, conducted intricate studies on the intracranial course of the nerve. In his findings, he identified that the abducent nerve passes through a narrow sinus near the apex of the petrous bone, which formed an osteofibrous canal. Dorello suggested that in this enclosed region the abducent nerve may be particularly vulnerable to compression due to the vascular edema accompanying the infection. Although his work was widely appreciated, it was not well received by all. Interestingly, Giuseppe Gradenigo, one of the most prominent Italian otologists of the early 20th century, who was known for his work on a triad of symptoms (Gradenigo’s syndrome) that accompanies petrous apicitis, a result of severe middle ear infections, was obstinate in his criticism of Dorello’s findings. Thus a scientific duel began, with a series of correspondence between these two academics—one who was relatively new to the otological community (Dorello) and one who was well reputed in that community (Gradenigo). The disagreement ultimately ebbed in 1909, when Dorello published a report in response to Gradenigo’s criticisms and convinced Gradenigo to change his views. Today Dorello’s canal is widely recognized as a key landmark in skull base surgery of the petroclival region and holds clinical significance due to its relation to the abducent nerve and surrounding vascular structures. Yet, although academics such as Dorello and Gradenigo are recognized for their work on the canal, it is important not to forget the others throughout history who have contributed to the modern-day understanding of this anatomical structure. In fact, although the level of anatomical detail found in Dorello’s work was previously unmatched, the first description of the canal was made by the experienced Austrian anatomist Wenzel Leopold Gruber in 1859, almost 50 years prior to Dorello’s landmark publication. Another critical figure in building the understanding of Dorello’s canal was Harris Holmes Vail, a young otolaryngologist from Harvard Medical School, who in 1922 became the first person to describe Dorello’s canal in the English language. Vail conducted his own detailed anatomical studies on cadavers, and his publication not only reaffirmed Dorello’s findings but also immortalized the eponym used today—“Dorello’s canal.” In this article the authors review the life and contributions of Gruber, Dorello, Gradenigo, and Vail, four men who played a critical role in the discovery of Dorello’s canal and paved the way toward the current understanding of the canal as a key clinical and surgical entity.

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Giuseppe Gradenigo: Much more than a syndrome! Historical vignette

Cited by 11 publications

References 13 publications

Gradenigo’s syndrome: a petrous apex lesion

Gradenigo’s syndrome: a petrous apex lesion

Gradenigo’s Syndrome in a Patient with Chronic Suppurative Otitis Media, Petrous Apicitis, and Meningitis

Gruber, Gradenigo, Dorello, and Vail: key personalities in the historical evolution and modern-day understanding of Dorello’s canal

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