Skull base osteomyelitis in patients with head and neck cancer: Diagnosis, management, and outcomes in a case series of 23 patients

Laryngoscope Investigative Otolaryngology

article

Mary M. Czech MD, MS¹  Peter H. Hwang MD²  Alexander Dimitrios Colevas MD²  Nancy Fischbein MD²  Dora Y. Ho MD, PhD¹ 

[1]Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine

[2]Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine

[3]Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine

[4]Department of Radiology, Stanford University School of Medicine

[5]Department of Neurology and Neurological Sciences, Stanford University School of Medicine

[6]Department of Neurosurgery, Stanford University School of Medicine

关键词: head and neck cancer;    nasopharyngeal carcinoma;    osteoradionecrosis;    skull base osteomyelitis;   

DOI  :  10.1002/lio2.719

学科分类：环境科学（综合）

来源: Wiley

【 摘 要 】

Background Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well-recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. Methods We conducted a retrospective chart review of HNC patients diagnosed with SBO. Results SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/oropharyngeal flora, but half of the patients additionally had antibiotic-resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/− 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base. Conclusions Diagnosis and management of SBO in HNC patients are challenging. Recommendations to aid in clinical care are proposed. Level of evidence 4, case series.

【 授权许可】

CC BY|CC BY-NC-ND