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The hemorrhagic granulation tissue filled the mastoid cavity and the tympanostomy tube in the tympanic membrane.
Source publication
Luc's abscess is an extremely rare complication of otitis media, caused by the spread of the middle ear infection to the subperiosteal area and its accumulation beneath the temporal muscle. Unlike other subperiosteal abscesses relating to otitis media, infection may not be associated with mastoid bone involvement. Therefore, it is defined as a beni...
Similar publications
Middle ear infection occurs when fluid accumulate in middle ear as a result of inflammatory response to viral or bacterial infection. Infections may spread from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Luc abscess is a rare complication of otitis media. The difference of this complication with other extra...
Objective
To assess the repair method of exposure or fracture of the porous high-density polyethylene ear framework after total auricle reconstruction.
Study design
A prospective case study.
Methods
From April 2018 to October 2021, 11 patients with framework exposure or fracture after total auricle reconstruction were admitted to the hospital for...
Citations
... 1,2 This is attributed to the infection passing through the notch of Rivinus and deep auricular arteries leading towards the subperiosteal plane beneath the temporalis or may also pass directly through the mastoid air cells. 2,3 These classic findings show a stark contrast to our presented case, where other otitis media complications were also present. ...
... The cause of this condition may be age-related, being attributed to acute otitis media in younger age groups and to chronic infections or immunosuppression in older populations. 2,4 Our patient was neither pediatric nor immunosuppressed. The microbiologic etiology of this condition is mainly bacterial in nature with Streptococcus pyogenes being the most common cause. ...
Luc’s abscess is an uncommon complication of otitis media wherein a subperiosteal abscess develops into the temporalis muscle and follows the route of a pneumatized zygoma.1 In uncomplicated cases, surgical drainage and antibiotics are adequate management with mastoidectomy reserved for severe or complicated cases. We report a case of complicated Luc’s abscess presenting with many complications that required multiple surgical interventions. CASE REPORT A 23-year-old man had a three-month history of yellowish, mucoid, foul-smelling left ear discharge associated with multiple episodes of non-projectile watery vomiting (< 1 cup each) and left-sided facial paresis. These symptoms were accompanied by ipsilateral hearing loss, tinnitus and dizziness prompting consult and admission to a secondary hospital. A cranial Computed Tomographic (CT) scan showed a cholesteatoma in the left ear. The facial asymmetry improved, vomiting was resolved with intravenous antibiotics, hydration, and an anti-emetic, and he was subsequently discharged. He continued to have recurrent, foul-smelling left ear discharge and left hemifacial paresis persisted. Left-sided otorrhagia and ipsilateral hemifacial paresis were subsequently associated with left hemifacial swelling, otalgia (VAS of 7/10, described as sharp), and decreased hearing, prompting an outpatient consult with a private ENT specialist. The symptoms persisted despite 7 days of oral ciprofloxacin, this time associated with drowsiness, neck pain and febrile episodes. The patient consulted in our institution and was advised emergency admission. He was admitted drowsy, coherent with GCS 15 (E4V5M6). The left temporal area was edematous and tender, extending to the ipsilateral post-auricular area inferiorly and frontal area superiorly. (Figure 1) Otoscopy revealed yellowish, foul-smelling, copious muco-purulent discharge and near-total perforated left tympanic membrane. The right ear had unremarkable otoscopic findings. Tuning fork tests at 512 Hz were consistent with sensorineural hearing loss in the left ear with House-Brackmann IV facial nerve paresis. Brudzinski and Kernig tests were negative with no signs of dysmetria, dysdiadochokinesia or dysarthria on cerebellar testing. Gram stain and KOH smears of the left ear discharge revealed C fruendii and fungal elements. High resolution temporal bone CT scan showed otomastoid disease on the left with automastoidectomy defect, associated subperiosteal and intracerebral abscess formation on the left, with otherwise unremarkable right temporal bone. (Figure 2)
... Luc's abscess is only encountered in the case reports, even though it was presented as a relatively benign course compared to other subperiosteal abscesses (2,3). Another feature distinguishing Luc's abscess from other complications is the possibility of delay in differential diagnosis due to its rare nature (1). In order to prevent the process of life-threatening complications, early identification is vital. ...
Luc’s abscess is rarely seen complications of otitis media with case reports from the literature despite being known as a benign course. A few cases have been reported combined with chronic suppurative otitis media, unlike other subperiosteal abscesses due to otitis media. Although Luc’s abscess is remarkable with its distinctive clinical features, early diagnosis may require high suspicion and sufficient clinical experience of clinicians. In case of clinical doubt, the clinician should not hesitate to request further research. A Highresolution computed tomography scan is necessary for determining the extent of disease and treatment planning as soon as possible. Here we present the case of a twelve-year-old boy with Down syndrome diagnosed with Luc’s abscess involving the mastoid bone and developed preseptal cellulitis in both eyes progressed to life-threatening processes. We discussed the clinic features and decision of treatment options of the patients in the light of the literature.
... Both aerobic and anaerobic bacteria have been found as the causative agents in the abscess cultures. Therefore, broad spectrum antibiotics should be used for the empirical treatment until the final aspirate culture and microbiological advice reports return [5]. ...
... Otitis media is one of the most frequently diagnosed and treated childhood diseases [1]. Although it is often self-limiting, there are important complications of the disease due to its proximity to the intracranial and intratemporal compartments. ...
... Although it is often self-limiting, there are important complications of the disease due to its proximity to the intracranial and intratemporal compartments. Complications of otitis media can be divided into intracranial and extracranial [1]. The extracranial complications are further divided into intratemporal or extratemporal complications. ...
... He believed the infection spreads via submucosal tissues after having found no evidence to suggest a correlation between the subperiosteal temporal abscess and the development of mastoiditis. Luc abscess is often associated with reduced or compromised immune status such as paediatric age group, elderly, and in patients with other comorbid like diabetes mellitus [1]. Asha'ari et al reported one elderly case with underlying diabetes mellitus presented with acute otitis media complicated with subperiosteal abscess [3]. ...
Middle ear infection occurs when fluid accumulate in middle ear as a result of inflammatory response to viral or bacterial infection. Infections may spread from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Luc abscess is a rare complication of otitis media. The difference of this complication with other extracranial abscesses relating to otitis media is, it may not be associated with mastoid bone involvement. Therefore, it is defined as benign complication of otitis media. Here, we report a case of 10-month-old baby boy diagnosed with Luc abscess with mastoid involvement.
... Eighteen articles were included for the review [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] ( Table 1 ). The selection process is described in the flowchart in Fig. 3 . ...
Objectives:
Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients.
Methods:
A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised.
Results:
Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy.
Conclusions:
The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient.
Introduction:
Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media.
Methods:
A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021.
Results:
Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%.
Conclusions:
There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.
Introduction
An uncommon complication of Acute Otitis Media (AOM) is a subperiosteal temporal infection known as Luc's abscess. Zygomatic air cells (ZACs) are an uncommon anatomic variant.
Case series
Two otherwise healthy male patients, aged six- and thirteenyears-old presented with unilateral otalgia, swelling, trismus, and fever. Imaging revealed Luc's abscess near ZACs. Antibiotics, drainage and myringotomy tubes resulted in a full recovery.
Conclusion
In addition to the spread of soft tissue infection through the Notch of Rivinus, the presence of ZACs may provide a pathway for suppurative effusion and development into Luc's abscess.
Purpose of review:
Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management.
Recent findings:
Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery.
Summary:
Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
