Anomalous Facial Nerve in a Case of Atticoantral Chronic Otitis Media with Mastoid Abscess

Abstract

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.