Epidural Empyema: A Devastating Complication of Craniofacial Surgery a Case Report

Abstract

Postoperative wound infection is a major complication of surgery. Infection following transcranial surgery is particularly devastating because of its life threatening potential. We report a case of an overwhelming epidural empyema and secondary osteomyelitis of the frontal bone after a transcranial procedure for the forehead advancement in a 2 year-old girl with Crouzon's syndrome. The cultured pathogen was staphylococcus viridescene. Patient survived after aggressive surgical drainage of pus and debridement of the infected bone and intravenous antibiotics. However, there was a 50% resorption of the frontal bone flap by clinical evaluation in 11 months follow up. The likely causes of infection in these case were the lengthy operative procedure, CSF leakage and early removal of drainage tube. A high level of suspicious is necessary in these patients and any sign of infection such as persisting fever should warrant immediate investigation. A CT scan in this case might have pick up the empyema early. Once detected, aggressive surgical debridement should be conducted promptly and repeatedly if necessary even though this may result in detectable bone loss.