Petrositis

Description:

Petrositis  (petrositis; annate. pars petrosa ossis temporalis a pyramid of a temporal bone + - um), or osteomyelitis of a top of a pyramid of a temporal bone, is usually observed during or after (in 3-4 days) acute average otitis or a mastoiditis, is much more rare at chronic average otitis - an inflammation of a pyramid of a temporal bone; complication of purulent average otitis.

Petrositis reasons:

The petrositis is caused by spread of an infection on a body and a top of a stony bone.

Pathogeny:

The petrositis can complicate the course of both acute, and chronic average otitis and to proceed as acute or chronic osteit or as an invasion a cholesteatoma. Besides, it can complicate operations on a mastoid (at which aeration or a drainage of cells of a stony bone is broken) both in early, and in the remote period. The infection reaches cells of a stony bone in several ways.

Petrositis symptoms:

The main symptom of a petrositis is the headache, usually spastic and felt far ahead of an ear. Paralysis of the taking-away (VI) cranial nerve on the party of defeat is possible, the nerve caused by puffiness of the channel, in which passes below a sheaf between a stony part of a temporal bone and the inclined shoots of a wedge-shaped bone in the field of a top of a stony bone.

Gradenigo described a triad of symptoms at petrosites:  otitis, an epileptiform neuralgia and paralysis of the taking-away nerve. The most frequent symptom are severe pains which irradiate to the temporal area, a mandible and in eye-socket depth. They are caused by collateral hypostasis of branches of a trifacial and gasserovy node. Paralysis of the taking-away nerve usually indicates existence of the limited meningitis proceeding from a pyramid top.

Symptoms are expressed with various force depending on a full or incomplete otgranicheniye of a suppurative focus. At increase in pressure the portion of pus breaks outside (in a middle ear), and then there comes simplification. The period of relative wellbeing is observed also at the known baryerization of process (the suppurative focus is surrounded with granulyatsionny fabric - a latent petrositis). However quite often there is a new flash of process at which pus breaks through a barrier and can lead to an intracranial complication.

The following picture of a disease is characteristic of the "late" petrositis observed in the postoperative period after a mastoidotomy: the health of the patient not only does not improve as it usually happens after a mastoidotomy, but even worsens - there is a headache, rise in temperature to high figures, pains in the depth of an eye-socket, a pus pulsation in outside acoustical pass, in the depth of an antral wound. After removal of pus the wound is again quickly filled with slivkoobrazny pus.

Diagnosis:

The diagnosis at typical displays of a disease is easy, especially when paralysis of the taking-away nerve and trigeminal pains join. Great difficulties are presented by diagnosis of latent petrosites; at them temporarily baryerizovanny center can suddenly become the reason of an intracranial complication. Therefore even at the erased symptoms of a petrositis it is necessary to watch dynamics of process (to repeatedly investigate blood on a leukocytosis and ROE, an eyeground and if necessary - cerebrospinal fluid).

One of important diagnostic receptions is the X-ray analysis. Sometimes the radiographic picture happens so clear that provides the correct diagnosis (destruction of a top of a pyramid). The best review of this area turns out at pictures on Stenversa. Difficulties at assessment of roentgenograms arise:
1) at dissimilarity of a structure of cellular systems of both pyramids - quite often one of tops has less accurate drawing of cells, than another; such changes can easily be treated as pathological;
2) at very small sizes of the center of destruction when it is blocked by a shadow of compact bone educations.

The method of repeated pictures is very valuable. At change of an initial picture it is possible to be sure available the progressing process.

Treatment of a petrositis:

Treatment of petrosites, like treatment of otitis and a mastoiditis, consists in use of high doses of penicillin, streptomycin, biomycin and other antibiotics (sometimes in a combination with each other) and streptocides.

Now an unconditional operative measure is demanded by the petrosites complicated by septic or intracranial processes. At the "early" petrositis which arose in an initial stage of acute otitis even at the expressed Gradenigo's symptom complex it is possible not to hurry with operation. At a "late" petrositis and the expressed symptoms of a disease careful observation using all diagnostic receptions and first of all a X-ray analysis, a research of cerebrospinal fluid, the neurologic status, a condition of function of a labyrinth etc. is required. At "platform" of symptoms and furthermore at their increase operation on a mastoid with opening, whenever possible, of all perilabirintny cells, with careful searches of the cellular courses to a pyramid top (upper and back), expansion and sounding of their openings is shown.
The greatest surgical activity is demanded by petrosites which arise during the postoperative period after the made mastoidotomy. In these cases audit of a wound at which the centers which remained unextracted are removed is shown, and the main attention is paid to detection of perilabirintny cellular ways.

If these unloading operations do not lead to the purpose and the closed suppurative focus in a pyramid top was formed, interventions on the top are shown.

There are four types of operations at a petrositis:
1. Operation through a mastoidalny wound (on Frenknera). Sometimes (at the corresponding cellular course) it is possible to pass a small spoon under a circle of the upper semicircular channel towards a top of a pyramid and to connect this deep center to a mastoidalny wound. Other way consists in an exposure of an upper surface of a pyramid through an additional trepanation opening in scales of a temporal bone.
2. Operation through a drum cavity. At this operations make expanded radical operation with the maximum knocking down of a spur that it was possible to see well промонториум and the mouth of an Eustachian tube. Bypassing a labyrinth array from below and in front, reach a pyramid top. Approach to it can be expanded a little if to bare a wall of an internal carotid artery and to remove it aside (across Ramadye).
3. Operation through a labyrinth. It is admissible only at a simultaneous purulent labyrinthitis, is dangerous by a possibility of wound of a facial nerve and therefore is less convenient.
4. Combined method. Broad access to a pyramid is reached through anteroinferior approach (like Ramadye) at a simultaneous wide exposure of a surface of a pyramid to a top.

The forecast at timely treatment in case of lack of complications, as a rule, favorable.