Simultaneous coexistence of complications of COM in the same case is a rare situation, and the present report describes a case with mastoiditis, Bezold abscess, lateral sinus
thrombophlebitis, meningitis, and paraspinal abscess.
1] With otogenic infection the close proximity of the middle ear and mastoid to the dural venous sinuses predispose these regions to lateral sinus
3) More specifically, otomastoiditis, when occurring in immunosuppressed patients, has the potential to progress to serious, life-threatening intracranial complications including meningitis, intracranial abscess, and lateral sinus
Otogenic lateral sinus
thrombosis (LST) is a rare but serious intracranial complication of acute or chronic otitis media.
These evaluated vascular anomalies and variants were diagnosed on the following previously described criteria [Figure 1]: (1) High jugular bulb, the jugular bulb extended above the inferior border of the round window; [sup] (2) dehiscent jugular bulb or dehiscent sigmoid plate, the incomplete thin bone around the jugular bulb or the sigmoid sinus; [sup], (3) jugular bulb diverticulum, prominent protrusion or an irregular out-pouching of jugular bulb that was clearly distinguished from a smooth ellipsoidal form; [sup] (4) sigmoid sinus diverticulum, a diverticulum entered into the mastoid bone; [sup] (5) lateral sinus
stenosis, the L/S ratio (L = the largest area of the vein; S = the smallest area of the vein) was >4.
3] In lateral sinus
thrombosis constitutional symptoms, ear discharge, mastoid tenderness, and signs and symptoms suggestive of raised intracranial tension found.
Then an access window was prepared into the lateral sinus
wall with a round diamond bur.
The posterior superior alveolar artery (PSAA) and infraorbital artery (IOA) are the branches of the maxillary artery that supply the lateral sinus
wall and overlying membrane.
At the level of the Meckel's cave the lateral sinus
wall blends into the dura covering it.
The ball entered through the occipital bone about one inch to the left of the median line and just above the left lateral sinus
, which it opened.
28%) had thrombosis of superior sagittal sinus followed by lateral sinus
Step 2: Clinical view showing preparation of the lateral sinus