Juvenile nasopharyngeal angiofibroma| aetiology, diagnosis, treatment

What is meant by Petrositis?

 Inflammation and abscess formation of the air cells situated in the petrous apex.

Causes and pathology of Petrositis

• It occurs as an extension of inflammation from the mastoid air cells, and so it resembles mastoiditis in pathology (i.e. destruction of the bony cell walls). But differs in symptomatology because of the different anatomical relationships.
  
• Petrositis occurs less commonly than mastoiditis because, whereas 80% of mastoid bones are pneumatized, only 30% of petrous bones have air cells extending to the apex.
• Petrositis occurs in patients with poor resistance as old diabetics.

Clinical picture and diagnosis of Petrositis

Gradenigo’s triad which consists of:

1. Pain: Severe retro orbital pain due to irritation of the trigeminal ganglion.
2. Diplopia: Due to paralysis of the Abducent nerve leading to lateral rectus muscle paralysis.
3. Discharge: From the ear of the same side.

Treatment of Petrositis:

1. Medical treatment by intensive antibiotic therapy and control diabetes.

2. Surgical intervention by a mastoidectomy with curettage of the fistulous track that carried the infection for the mastoid air cells to the petrous apex air cells, so as to drain the petrous apex (petrous apicetomy ).

References

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