Suppuration of the Petrous Pyramid: Some Views on Its Surgical Management

Myerson, Mervin C.

doi:10.1001/archotol.1937.00650020048006

Cited by 11 publications

(4 citation statements)

References 3 publications

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“…The discovery and use of antibiotics have succeeded in converting what was uncommon into a rarity. In 1937, Myerson estimated that suppuration in the petrous apex occurred once in every 300 cases of otitis media. Today, the incidence may be smaller than 2:100,000 patients with otitis media …”

Section: Introductionmentioning

confidence: 99%

The changing face of petrous apicitis—a 40‐year experience

Gadre

Chole

2017

The Laryngoscope

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Section: Introductionmentioning

confidence: 99%

The changing face of petrous apicitis—a 40‐year experience

Gadre

Chole

2017

The Laryngoscope

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“…Whereas the former can be watched and treated with antibiotics, the latter, comprising 20% of cases, necessitated surgical intervention because there is a tendency for intracranial extension and subsequent meningitis. 20,21 Lempert contended that surgeons who believed that suppurative apicitis could be treated by a simple mastoidectomy and drainage of more posterior portions of the petrous bone at the petrous-mastoid junction had falsely made that attribution because in many cases they were in fact treating congestive apicitis, which could have been treated conservatively. According to Lempert, roentgenologic evidence of suppuration should push the surgeon to perform aggressive surgery.…”

Section: Early Improvementsmentioning

confidence: 99%

Early Conquest of the Rock: Julius Lempert's Life and the Complete Apicectomy Technique for the Treatment of Suppurative Petrous Apicitis

2014

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Julius Lempert (1891?1968) was one of the most revolutionary and innovative neuro-otologists of the 20th century. He had a remarkable role in advancing the field of otolaryngology to its modern shape and form, especially through his groundbreaking introduction of the fenestration procedure for the treatment of otosclerosis. Although he is highly celebrated by many neuro-otologists for his contributions to our surgical and anatomical understanding of the petrous bone, he is not well known to the neurosurgical community. In this article, we give a detailed account of Dr. Lempert's life and discuss his invaluable contribution to skull base petrous bone anatomy and surgery through his pioneering work on the complete apicectomy for the treatment of suppurative petrous apicitis.

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“…With the advent and widespread use of antibiotics, life-threatening complications of OM, such as petrous apicitis (PA), have become very rare. In 1937, it was estimated that PA occurred once in every 300 cases of OM [ 1 ]. Today, the incidence is likely less than 2 in every 100 000 cases of OM [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

Ibrahim,

Fox-Lewis,

Correia

2023

Am J Case Rep

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Patient: Male, 21-year-old Final Diagnosis: Gradenigo syndrome • petrous apicitis • thrombosis of the cavernous sinus Symptoms: Cranial nerve palsy • facial numbness • headache • hearing loss • otalgia • otorrhea Clinical Procedure: Mastoidectomy Specialty: Infectious Diseases • Neurosurgery • Otolaryngology • Surgery Objective: Rare disease Background: With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more uncommon is Gradenigo syndrome (GS), a result of PA, characterized by a triad of otitis media or purulent otorrhea, pain within the regions innervated by the first and second division of the trigeminal nerve, and ipsilateral abducens nerve palsy. Recent literature has demonstrated increasing reports of Fusobacterium necrophorum isolated in cases of GS. Case Report: A 21-year-old man presented with otalgia, reduced hearing, and severe headache. Examination revealed right-sided purulent otorrhea, anesthesia within the trigeminal nerve distribution, and an ipsilateral abducens nerve palsy. F. necrophorum was isolated from an ear swab and a blood culture. Computed tomography and magnetic resonance imaging (MRI) demonstrated otomastoiditis, PA, cavernous sinus thrombosis, and severe stenosis of the petrous internal carotid artery. He was treated with intravenous benzylpenicillin, underwent a mastoidectomy and insertion of a ventilation tube, and was started on a 3-month course of dabigatran. Interval MRI showed improved internal carotid artery caliber, persistent petrous apex inflammation, and normal appearance of both cavernous sinuses. Follow-up clinical review noted persistent abducens and trigeminal nerve dysfunction. Conclusions: We identified 190 cases of PA; of these, 80 presented with the classic Gradenigo triad. Fusobacterium sp. were cultured in 10% of GS cases, making them the most frequent isolates. Due to the fastidious nature of F. necrophorum, it may be underrepresented in the historical literature, and we recommend that empiric antibiotics cover anaerobic organisms.

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Suppuration of the Petrous Pyramid: Some Views on Its Surgical Management

Cited by 11 publications

References 3 publications

The changing face of petrous apicitis—a 40‐year experience

The changing face of petrous apicitis—a 40‐year experience

Early Conquest of the Rock: Julius Lempert's Life and the Complete Apicectomy Technique for the Treatment of Suppurative Petrous Apicitis

Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

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