Abstrakt
We report on a 70-year-old patient who suffered from chronic osteomyelitis of the frontal bone following trauma. He underwent a common nasal polypectomy and shortly after the procedure, he developed nasal liquorrhea from the right nostril.
CT images showed a pneumocephalus and a defect in the right part of the ethmoidal bone (Fig. 1). First, the ear, nose and throat (ENT) surgeon indicated closure of the defect with a nasoseptal flap, which showed no effect.
A team consisting of a maxillar surgeon, neurosurgeon and ENT surgeon tried to close the defect of the rhinobasis using the pericranial flap for cranialization of the frontal sinus. After the procedure the liquorrhea stopped; however, 2 weeks after the operation the patient's state deteriorated.
He started to be septic with purulent meningitis. PET-CT showed no infectious focus, but repeated nasal endoscopy showed a purulent slime mass.
The smears from the rhinobasis and hemoculture examination confirmed the extended-spectrum beta-lactamase producing Klebsiella pneumonie and coagulase negative Staphylococcus. Repeated CT and MRI showed no intracranial infectious complication and good cranio-nasal separation.
However, the patient was septic, he developed a heavy psychoorganic syndrome and he needed vasopresor therapy with norepinephrine. After repeated nasal endoscopy and debridement, the defect in the rhinobasis reoccurred.
Therefore, a team of physicians came up with the last possible solution - closure of the rhinobasis defect with a free muscle flap.