gms | German Medical Science

Introduction: Osteomyelitis of the frontal bone is a rare sinunasal complication in childhood. Possible development of an epidural or intracerebral abscess formation requires earliest operation. The combination of computed tomography and magnetic resonance imaging seem to be necessary to get optimal overview of all bone and brain alterations.

Case history: A 5-year-old boy complaining of rapid ongoing swelling of his forehead was admitted to our hospital. A few days ago he presented a slight respiratory infection. During physical examination a dolent, doughy frontal fluctuation about 5 x 5 cm was detected, no other abnormalities. Neither meningism nor pathological rhinorrhea did occur. The boy was in a good general condition. Computed tomography revealed a liquid frontal alteration and osteolytic change of the external and internal frontal tabulae. Existing sinus of the right side had been involved. The MRI demonstrated a right frontal meningeal enhancement. Suspected osteomyelitis of the frontal bone including right epidural abscess formation due to an acute pansinusitis lead to a surgical treatment.

Conclusion: Even in not yet present sinuses a simple respiratory infection may lead to an osteomyelitis of the frontal bone via a retrograde thrombophlebitis. Secondary to its distincted spongiosa the frontal bone seems to be predestinated for osteolytic alterations.