Limits...
Calvarial tuberculosis of the parietal bone: A rare complication after dental extraction.

Nair AP, Mehrotra A, Das KK, Kumar B, Srivastav AK, Sahu RN, Kumar R - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: The patient was operated upon and the biopsy was suggestive of tubercular pathology.The patient improved on antitubercular therapy.The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT
Tuberculosis (TB) is a well-known endemic in developing countries. However calvarial TB is quiet rare even in such endemic areas. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the right temporal region with pus discharging sinus after an episode of tooth extraction for dental infection. Radiology revealed a loculated swelling within the right temporalis muscle and an associated bony defect in the right parietal bone. The patient was operated upon and the biopsy was suggestive of tubercular pathology. The patient improved on antitubercular therapy. The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging T2-WI showing T2 hyper intensity within the temporalis muscle that is hypo on T1-WI
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4553736&req=5

Figure 2: Magnetic resonance imaging T2-WI showing T2 hyper intensity within the temporalis muscle that is hypo on T1-WI

Mentions: The present case report is about a 40-year-old male patient presented with the complaints of swelling in the right temporal region for 4 months. On detailed evaluation, he gave a history of dental infection leading to tooth extraction following which the swelling started. In addition, he also complained of holocranial headache of 15 days duration. On examination, the swelling was 3 × 3 × 4 cm in size and was non pulsatile, soft and fluctuant with ill-defined and diffuse borders. A small defect was palpable in the right parietal bone posterior to the swelling. At 24 h after admission, he developed sinuses over the swelling that were discharging pus. CT head revealed a defect of size 2 × 2 cm in the right parietal bone with irregular margins and the defect was involving both the inner and outer tables. The bony edge was undermined with an extradural collection of size 0.5 × 0.5 cm [Figure 1a and b]. There was a collection within the right temporal muscle that was extending down into the infrazygomatic region suggestive of an abscess [Figure 1c]. MRI revealed a T1 hypo T2 hyperintense well defined lesion situated within the right temporalis muscle and an extradural heterointense lesion below the bony defect [Figure 2a and b]. However there was no evidence of intracranial extension. Bone scan of the patient was done and showed increased uptake in the right parietal bone suggestive of osteomyelitis. However as it could be either pyogenic or tubercular in etiology, a detailed evaluation for TB was undertaken. His chest X-ray showed a well-defined opacity in the right upper lobe. Erythrocyte sedimentation rate (ESR) was 60 mm at the end of 1st h and Mantoux was positive. TB interferon gamma was done and was positive. Since he had a discharging sinus and a temporal collection he was posted for surgery. A right sided reverse question mark incision was made exposing the temporalis muscle and the defect in the right parietal bone. A large portion of the temporalis muscle was replaced by necrosed tissue and pus [Figure 3]. The pus was extending inferiorly to involve the temporalis muscle below the zygoma. Thorough debridement of the devitalized tissue was done. The defect in the parietal bone was nibbled all around and sent for histopathological examination. There was granulation tissue located extradurally just beneath the defect. It was scooped out and sent for biopsy. After debridement, saline and betadine irrigation was done and the wound closed. Patient was started on antitubercular therapy with isoniazid, rifampicin, pyrazinamide and streptomycin as he was not receiving any antibiotics prior to surgery. Microscopy was negative for Grams staining and cultures were sterile. Histopathology report came as caseating granulomas with epitheloid cells, Langhans giant cells with acid fast bacilli seen. Post-operative period was uneventful. Sutures were removed on the 7th post-operative day and patient was discharged. At a follow-up of 4 weeks, patient has no swelling and the wound is well-healed.


Calvarial tuberculosis of the parietal bone: A rare complication after dental extraction.

Nair AP, Mehrotra A, Das KK, Kumar B, Srivastav AK, Sahu RN, Kumar R - Asian J Neurosurg (2015 Jul-Sep)

Magnetic resonance imaging T2-WI showing T2 hyper intensity within the temporalis muscle that is hypo on T1-WI
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553736&req=5

Figure 2: Magnetic resonance imaging T2-WI showing T2 hyper intensity within the temporalis muscle that is hypo on T1-WI
Mentions: The present case report is about a 40-year-old male patient presented with the complaints of swelling in the right temporal region for 4 months. On detailed evaluation, he gave a history of dental infection leading to tooth extraction following which the swelling started. In addition, he also complained of holocranial headache of 15 days duration. On examination, the swelling was 3 × 3 × 4 cm in size and was non pulsatile, soft and fluctuant with ill-defined and diffuse borders. A small defect was palpable in the right parietal bone posterior to the swelling. At 24 h after admission, he developed sinuses over the swelling that were discharging pus. CT head revealed a defect of size 2 × 2 cm in the right parietal bone with irregular margins and the defect was involving both the inner and outer tables. The bony edge was undermined with an extradural collection of size 0.5 × 0.5 cm [Figure 1a and b]. There was a collection within the right temporal muscle that was extending down into the infrazygomatic region suggestive of an abscess [Figure 1c]. MRI revealed a T1 hypo T2 hyperintense well defined lesion situated within the right temporalis muscle and an extradural heterointense lesion below the bony defect [Figure 2a and b]. However there was no evidence of intracranial extension. Bone scan of the patient was done and showed increased uptake in the right parietal bone suggestive of osteomyelitis. However as it could be either pyogenic or tubercular in etiology, a detailed evaluation for TB was undertaken. His chest X-ray showed a well-defined opacity in the right upper lobe. Erythrocyte sedimentation rate (ESR) was 60 mm at the end of 1st h and Mantoux was positive. TB interferon gamma was done and was positive. Since he had a discharging sinus and a temporal collection he was posted for surgery. A right sided reverse question mark incision was made exposing the temporalis muscle and the defect in the right parietal bone. A large portion of the temporalis muscle was replaced by necrosed tissue and pus [Figure 3]. The pus was extending inferiorly to involve the temporalis muscle below the zygoma. Thorough debridement of the devitalized tissue was done. The defect in the parietal bone was nibbled all around and sent for histopathological examination. There was granulation tissue located extradurally just beneath the defect. It was scooped out and sent for biopsy. After debridement, saline and betadine irrigation was done and the wound closed. Patient was started on antitubercular therapy with isoniazid, rifampicin, pyrazinamide and streptomycin as he was not receiving any antibiotics prior to surgery. Microscopy was negative for Grams staining and cultures were sterile. Histopathology report came as caseating granulomas with epitheloid cells, Langhans giant cells with acid fast bacilli seen. Post-operative period was uneventful. Sutures were removed on the 7th post-operative day and patient was discharged. At a follow-up of 4 weeks, patient has no swelling and the wound is well-healed.

Bottom Line: The patient was operated upon and the biopsy was suggestive of tubercular pathology.The patient improved on antitubercular therapy.The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT
Tuberculosis (TB) is a well-known endemic in developing countries. However calvarial TB is quiet rare even in such endemic areas. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the right temporal region with pus discharging sinus after an episode of tooth extraction for dental infection. Radiology revealed a loculated swelling within the right temporalis muscle and an associated bony defect in the right parietal bone. The patient was operated upon and the biopsy was suggestive of tubercular pathology. The patient improved on antitubercular therapy. The rare presentation of calvarial TB occurring secondary to dental infection along with relevant literature is discussed here.

No MeSH data available.


Related in: MedlinePlus