(A1107) Central Skull Base Osteomyelitis Post Adenotonsillectomy: Case Report

Introduction: Adult tonsillectomy and adenoidectomy are performed less commonly than in the pediatric population. As such, complications after adult adenotonsillectomy are not well described. Skull base osteomyelitis (SBO) after adenoidectomy is a rare complication with only one reported case in the pediatric literature. This case report describes the first reported adult SBO case after a routine adult adenotonsillectomy.

Methods: This is a retrospective review from a single hospital.

Results: A 53-year-old patient presented with a two-month history of chronic headache, weight loss, and right-sided tongue weakness after adenotonsillectomy for sleep-disordered breathing. A CT scan showing soft tissue swelling with possible fluid in the nasopharynx and erosion around the hypoglossal and carotid canal on the right. Subsequent MRI showed extensive phlegmon extending into the clivus and petrous apices with encasement of the internal carotid artery (ICA). Operative management utilizing direct laryngoscopy and nasal endoscopy with biopsy showed purulent drainage from the left side of the nasopharynx with right base of tongue asymmetry but no mucosal irregularities or masses. Pathology showed granulation tissue and acute inflammation. Final cultures grew Anaerobic Gram-Positive Cocci, Staphylococcus Epidermidis, and Streptococcus Constellatus. The patient was discharged on long term IV antibiotics. At follow up, she continued to have residual tongue weakness, but the rest of her symptoms improved, and follow-up MRI indicated resolution.

Conclusions: Management of Central SBO can include imaging to determine the extent of disease, endoscopy with biopsy to rule out malignancy, and obtaining cultures to identify pathogens for targeted antibiotic therapy. Finally, multidisciplinary follow-up is essential to monitor patient progression.