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A Novel Classification for the Rational Management of Lateral Skullbase Osteomyelitis

Sarrath Rathnaraajan, Amarnath Devarasetty, Adarsh Panicker, Sowmya Gajapathy, Raghunandhan Sampathkumar and Mohan Kameswaran

Background: Skull base osteomyelitis (SBO) is a serious life threatening condition if not identified and managed early. Though the incidence has reduced due to wide use of antibiotics, the increase in other coexisting morbidities leads the patient to usually present with high rate of complications.

Methods: Our institute being a tertiary referral center encounters a spectrum of such patients. The spectrum of prequel to skull base osteomyelitis varies in a large way from infection (Bacterial/Fungal) to post radiation and so diagnosing a patient who comes with vague complaints become very important. This article is a retrospective case review of a variety of manifestations of SBO which were managed using a systematic protocol over a decade (2008- 2018) at our institute. We classified SBO into stages for deciding upon the most appropriate plan of management based on the severity of the disease.

Results: Optimal outcomes were achieved with minimal morbidity while following a step-wise management protocol whereby treatment was focused on multimodal therapy including intense diabetic control, appropriate antibiotic therapy and early surgical intervention for debridement of necrotic bone and replenishment of vascularity within the surgical cavity.

Conclusion: A rational approach to management of SBO is paramount since the presentations may be subtle and may vary upto life threatening complications. Following a systematic protocol as described here will lead to better long term outcomes.