Luc’s AbscessLuc’s AbscessThe Return of an Old FellowThe Return of an Old Fellow

Tal Marom*, Inbal Weiss*, Abraham Goldfarb*, Eyal Russo*, Yehudah Roth*,φ

* Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel-Aviv University, Sackler School of Medicine, Holon, Israel

φ Dalla Lana School of Public health, University of Toronto, Ontario, Canada

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No potential conflicts of interests

Suppurative complications of AOMSuppurative complications of AOM

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• Mastoiditis

• Subperiosteal abscess

• Sigmoid vein thrombosis

• Less common in the post-antibiotic era

Case ICase I

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5 y/o boy with a 2-day right temporal region swelling

1 week before admission: right AOM, treated with

amoxicillin for 5 days

1 day before admission: right TMJ pain and

periauriclar swelling. No auricle protrudance, mild

TMJ swelling, without fluctuation or tenderness.

Treatment was switched to ibuprofen

Case ICase I

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On admission: right temporal region swelling ,

downward protrusion of the auricle and a retro-

auricular erythema; MEE; mild protrusion of the

antero-superior external canal skin

Body temperature was 37.7°c

Laboratory: leukocytosis (26,200) with neutrophilia

(77%), mild thrombocytosis (495,000), elevated CRP

(3.71 mg/dL, normal: <0.5)

Temporal Bone CT ScansTemporal Bone CT Scans

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Temporal Bone CT ScansTemporal Bone CT Scans

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TreatmentTreatment

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IV cefuroxime

After 24h: still febrile, increased local tenderness

Surgery: right paracentesis + VT; drainage of the

temporal region abscess via an external incision.

Culture positive for Streptococcus pyogenes.

IV antibiotics was switched to cefamizine, according to

culture sensitivities.

F/U was unremarkable

Case IICase II

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5 y/o boy presented with 1-day onset of fever and left

otalgia, with a protruding auricle.

Patient was febrile (38.8oc), no rertoauricular or

mastoid erythema or fluctuation, external ear canal

was normal, left AOM (myringotomy)

Laboratory :leukocytosis (20,500) with neutrophilia

(75%), elevated CRP (13.86 mg/dL, normal: <0.5).

Case IICase II

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IV cefuroxime + ototopical ciprofloxacin

Following 3 days of IV: no clinical improvement,

worsening of the periauriclar swelling, spiky fever,

ongoing otorrhea acute mastoiditis with a

subperiosteal abscess.

No CT performed

Case IICase II

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Surgery: left paracentesis + VT; drainage of the

temporal abscess via a rertoauricular incision;

cortical mastoidectomy

Mastoid bone showed no erosion with sclerotic air

cells and only mild granulation tissue in the attic.

F/U was unremarkable

Spread of InfectionSpread of Infection

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Henri Luc, 1900: subperiosteal temporal abscessHenri Luc, 1900: subperiosteal temporal abscess

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Luc H. The sub-periosteal temporal abscess of otic origin without intraosseous suppuration. Laryngoscope 1913; 23 (10): 999-1003.

SummarySummaryBacteria spread from middle ear cavity via

submucosal tissue plains (the incisure of Rivinus and

along the branches of the deep auricular artery) to

form an abscess deep to the temporalis muscle

One child was treated with limited local drainage

according to CT findings. The other underwent a more

extensive surgery based on clinical evaluation alone

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SummarySummary

Luc's abscess is associated with relatively little

morbidity and requires a more limited surgical

intervention

Temporal bone CT is of great value to evaluate the

extent of the disease and to avoid unnecessary

mastoid surgery

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