definition: osteomyelitis of skull/scalp in whereby pus collects under pericranium → swelling that becomes prominent over forehead or mastoids
HPI
history of fetal scalp monitoring
history of penetrating trauma to head
history of skull base / facial fractures
PHYSICAL EXAM
universal neuro exam
evaluate forehead swelling
evaluate mastoid swelling
IMAGING
CT: evaluate for bony resorption, periosteal reaction
MRI skull base w/wo: evaluate for contrast enhancement
A/P
generally operative for debridement, culturing, source control.
40 year old male presenting 18 years after facial trauma.
Patient suffered extensive cranio-facial trauma as a teenager (including frontal sinus anterior and posterior table fractures), recovered well following cranialization of frontal sinus, and presented 18 years later with forehead swelling. He underwent L maxillary anstrostomy, L anterior ethmoidectomy, and drilling of cranialized frontal sinus with removal of infected bone of skull base, orbit, and drainage of infected mucocele.
(A): CT with contrast showing moderate-severe dependent swelling in the forehead on presentation (B): complete opacification of L maxillary sinus is seen, consistent with severe sinusitis (C): completely opacified surgical post-surgical frontal sinus on the left. T1 without contrast (D) and T1 with contrast (E) demonstrating enhancement of frontal scalp and adjacent dura consistent with cellulitis +/- focal meningitis. (F) re-demonstration of severe maxillary sinusitis on left side.
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