Y j kim, k h chang, i c song, h d kim, s o seong, y h kim, m h han. Acute otitis media aom is a common selflimiting childhood illness usually managed medically. Deep neck abscess arising from acute mastoiditis, a disease thoroughly described by frederick bezold early in this century, has become rare. A bezold s abscess occurs as a complication of acute otomastoiditis and is currently an uncommon medical condition, due to the advent of antibiotics. A bezolds abscess is an organized collection of pus located deeply in the neck, in the sternocleidomastoid muscle and the infratemporal fossa.
It was first described in 1881, by a study in cadavers in which purulent secretion was observed draining from the medial. Bezold abscess is defined as a complication of acute mastoiditis when the disease passes inferiorly. It is complicated by rupture of the tympanic membrane and escape of pus into the digastric groove of the sternomastoid muscle, resulting in bezolds mastoiditis. Inferiorly, through apex of mastoid process, in the neck bezold abscess 36. We describe a patient with recurrent bilateral otalgia who had received multiple courses of antimicrobials who presented with severe headache, neck pain and right. This is a concise presentation for medical students especially from india. An abscess deep to the superior part of the sternocleidomastoid muscle due to suppurative destruction of the mastoid tip cells in mastoiditis. In november 1881, friedrich bezold published an article describing the sequale of pus escaping through the medial side of mastoid process in the incisura digastrica digatric groove and forming an abcess. The bezoldjarisch reflex has been suggested as a possible cause of profound bradycardia and circulatory collapse after spinal anesthesia and interscalene brachial plexus block.
Middle ear cultures may help in reducing use of broad spectrum antibiotics. Bezold s abscess as we know of today is very unlike the original description by bezold, in 1881. Objectiveshypothesis bezold s abscess and dural sinus thromboses are rare complications of otitis media in the era of antibiotics. Modern presentations of bezolds abscess jama otolaryngology. Bezolds abscess definition of bezolds abscess by medical. View or download all content the institution has subscribed to.
An unusual complication of chronic suppurative otitis media. This paper presents a case of bezold s abscess associated with chronic otitis media, with the unusual clinical finding of extension to the suprascapular. Pdf acute mastoiditis complicated with concomitant bezolds. Bezold s abscess arising with recurrent cholesteatoma 20 years after the first surgery.
Four cases of bezolds abscess is reported to illustrate the varied natural history of this rare. On the seventh day of admission, streptococcus pneumoniae sensitive to penicillin, mic pdf. Abscesses in relation to pharynx linkedin slideshare. Mastoiditis, bezold abscess, lateral sinus thrombophlebitis, and meningitis are all classic complications of otitis media, but this is the first paper in which these complications are reported to occur concomitantly. The bezold abscess seen occasionally with cases of acute otitis media has also become almost extinct. Due to it being deep to the investing layer of the deep cervical fascia that envelops the sternocleidomastoid. By spyros cardoso dimatos, luciano rodrigues neves, hugo valter lisboa ramos and oscar cardoso dimatos. Bezolds abscess in a diabetic patient without significant.
After six months of treatment he had complete resolution of infection and. Bezold abscess is a rare deep neck abscess resulting from an. Bezolds abscess synonyms, bezolds abscess pronunciation, bezolds abscess translation, english dictionary definition of bezolds abscess. Following pneumatisation, the cortical thickness of the mastoid is reduced allowing easier erosion and bezold abscess formation in the adult population 4. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. A bezolds abscess occurs as a complication of acute otomastoiditis and is currently an uncommon medical condition, due to the advent of antibiotics. Bezolds abcess presenting as parapharyngeal abcessc. My paper contains a detailed description of one of the most important and instructive cases of my aural practice.
Bezold s abscess is a rare complication of mastoiditis caused by necrosis of the mastoid tip allowing infection to migrate into the neck. The initial site where the abscess can be formed is the chin, and can then progress to an abscess formation in the. Bezolds abscess mastoiditis acute with neck abscess. She had been an unemployed person and she had no health insurance or welfare for over 10 years. Bezolds abscess is a deep cervical abscess arising from acute mastoiditis. Acute mastoiditis complicated with concomitant bezolds abscess. Bezold s and citellis abscesses are rare complications of otitis media. Anunusualcomplicationofchronicsuppurative otitis media. The relationship of 2 different diseases are poorly understood, although bezold s abscess could cause lemierres syndrome. Bezolds abscess is a suppurative complication of mastoiditis rarely seen in. Acute mastoiditis complicated with concomitant bezolds. The coexistence of lemierres syndrome and bezolds abscess.
Abscesses are usually caused by specific microorganisms that invade the tissues, often by way of small wounds or breaks in the skin. Bezolds abscess is a rare complication of mastoiditis caused by necrosis of the mastoid tip allowing infection to migrate into the neck. A serious complication of otitis media mcmullan 2009 journal of paediatrics and child health wiley online library. The initial site where the abscess can be formed is the chin, and can then progress to an abscess. A thirtyyearold female with bezold s abscess as well as untreated diabetes presented with a right otalgia and otorrhea at the end of december 2011. Bezold abcess is a very rare complication of this nature. Bezold abscess, although not a frequent complication, presents typically as cunatenous swelling in a case of chronic suppurative otitis media. Included is a discussion of mastoiditis and its management. It is, however, too long to be read before this society.
Retropharyngeal abscess clinical features dysphagia, difficulty in breathing, stridor, croupy cough, torticollis on examination. Weissman3 i n1908,bezoldandsiebenmann 1,2werethefirsttodescribeab scessesintheneckarisingfrom. A unique case of bezolds abscess associated with multiple. Imaging of complications of acute mastoiditis in children. However, she did not seek medical consult because she thought she couldnt pay the medical fees. I, therefore, would beg permission to read only a resume of it, and some general remarks, which i offer for. Bezolds abscess is a suppurative complication of mastoiditis rarely seen in the current era of antimicrobials. Lateral sinus thrombosis is another intracranial complication of acute mastoiditis that can occur, but there are only few reports of concomitant ispilateral bezolds abscess and lateral sinus thrombosis with favorable outcome. An extensive cholesteatoma with bezold s abscess article pdf available in international journal of clinical medicine 0203 january 2011 with 162 reads how we measure reads. Bezolds abscess is an abscess deep to the sternocleidomastoid muscle where pus from mastoiditis erodes through the cortex of the mastoid part of the temporal bone, medial to the attachment of sternocleidomastoid, extends into the infratemporal fossa, and deep to the investing layer of the deep cervical fascia. An abscess is a natural defense mechanism in which the body attempts to localize an infection and.
It was first described in 1881, by a study in cadavers in which purulent secretion was observed draining. Bezold abscess definition of bezold abscess by medical. Head and neck abscesses in complicated acute otitis media. We present a unique case report of bezold s abscess in association with multiple dural sinus thromboses.
A thirtyyearold female with bezolds abscess as well as untreated diabetes presented with a right otalgia and otorrhea at the end of december 2011. The involvement of otomastoid compartment is hypothesised to be of haematogenous origin. A localized collection of pus in part of the body, formed by tissue disintegration and surrounded by an inflamed area. Bezold s abscess is a deep cervical abscess arising from acute mastoiditis. Bezolds abscess is a deep cervical abscess arising from an acute case of mastoiditis. The condition is associated with a number of intra and extracranial complications including acute mastoiditis, sigmoid sinus thrombosis and intra or extracranial abscess. Bezolds abscess definition of bezolds abscess by the free. Bezold abscess is defined as a complication of acute mastoiditis when the disease passes inferiorly through the medial aspect of the mastoid tip into the sheath of the sternomastoid muscle. Pdf an extensive cholesteatoma with bezolds abscess. Bezold s abscess is an abscess deep to the sternocleidomastoid muscle where pus from mastoiditis erodes through the cortex of the mastoid part of the temporal bone, medial to the attachment of sternocleidomastoid, extends into the infratemporal fossa, and deep to the investing layer of the deep cervical fascia. Bezold abscess treatment includes broadspectrum antibiotic therapy and early surgery to establish drainage of the mastoid cells and neck space 4. A mastoiditis abscess deep in the muscle planes of the neck with suppuration in the mastoid tip cells. Rarely it can spread directly via tympanic membrane perforation or via reflux through eustachian tube. On the seventh day of admission, streptococcus pneumoniae sensitive to penicillin, mic bezolds abscess is a very rare extracranial complication of acute mastoiditis.
Bezolds abscess as we know of today is very unlike the original description by bezold, in 1881. With the advent of antibiotics, this disease has become extremely uncommon in our region. Due to it being deep to the investing layer of the deep cervical fascia that envelops the sternocleidomastoid muscle and trapezius. The difference between what is known today as a bezold s abscess and the abscess that bezold described in the early part of this century are presented. We present a case of a 44yearold eastern european man, with a history of recurrent otitis media, who was admitted to hospital with mastoiditis and initially treated with antibiotics. Bezolds and citellis abscesses are rare complications of otitis media. Bezolds abcess which was secondary to unsafe chronic suppurative otitis media. Since the introduction of antibiotics for the treatment of suppurative otitis. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail.
Bezolds abscess was diagnosed and the patient was treated empirically with ceftriaxone 2 g twice a day and metronidazole 500 mg three times a day. Further spread from bezold abscess is extremely rare. Bezolds abcess, cholesteatoma, lateral sinus thrombosis. Abstract this report describes a case of bezold s abscess, a rare complication of mastoiditis, following otitis media. Surgical treatment included myringotomy, cortical mastoidectomy, and bezolds abscess incision and drainage. It can lead to seriously sequelae if not diagnosed and treated early. Upright posture results in pooling of blood in the.
A bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid, at the attachment site of the posterior belly of the digastric muscle, and extends into the infratemporal fossa. Bezold s abscess is a suppurative complication of mastoiditis rarely seen in the current era of antimicrobials. It develops when suppuration products escape through the mastoid process medial side at the digastric fossa 1. A bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid, at the attachment site of the posterior belly of the digastric muscle, and extends into the. Bezolds abscess is a very rare extracranial complication of acute mastoiditis. In this video, we are going to see about bezold s abscess. Its occurrence in association with chronic otitis media has always been even less frequent. An unusual complication of chronic suppurative otitis. Congenital cholesteatoma of temporal bone with bezolds. Bezold abscess is less common in the paediatric population, prior to the development of the mastoid air cells.
It was introduced by a german otologist, friedrich bezold in 1881. Tuberculosis involving mastoid and ear is an uncommon entity presenting with myriads of nonspecific features and difficult to diagnose, being a paucibacillary condition. Formation of abcesses secondary to erosion of mastoid bone by cholesteatoma is a dreadful complication. Most common presentation is a retrotympanic pearly white mass with no previous. Risk factors include prior cholesteatoma and mastoidectomy. Despite clinical improvement, a ct scan showed mastoiditis with bezolds and citellis abscesses. According to literature, early surgical treatment generally is necessary to establish drainage of the mastoid cells and the cervical region12. Paediatric acute mastoiditis complicated by bezold abscess. The deep location in the neck means that they are often not palpable clinically. Lucs abscess as an unlucky complication of mastoiditis. Bezolds abscess synonyms, bezolds abscess antonyms. A case of antrotympanic disease and bezolds mastoid abscess.
Aeration of the mastoid bone with resulting thinning of the osseous walls is believed to be a predisposing factor for developing this abscess. When osteolysis occurs at the mastoid tip, the phlegmonous debris may extend inferiorly into the soft tissues of the neck and form an abscess referred to as the bezold abscess, 19. It may originate at various sites in the temporal bone, for example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or in the external auditory canal. Four cases of bezold s abscess is reported to illustrate the varied natural history of this rare. Pdf bezolds abscess is a very rare extracranial complication of acute mastoiditis. We diagnosed and treated successfully a 14yearold girl suffering from pdf print show related cases notify admin. Bezolds abscess with extension to the suprascapular space. Despite clinical improvement, a ct scan showed mastoiditis with bezold s and citellis abscesses.