Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4991-4997
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4991
Postoperative infection of the skull base surgical site due to suppurative parotitis: A case report
Yong Zhao, Yang Zhao, Li-Qin Zhang, Guo-Dong Feng
Yong Zhao, Yang Zhao, Li-Qin Zhang, Guo-Dong Feng, Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhao Y, Zhao Y and Feng GD substantially contributed to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; Zhao Y, Zhang LQ and Feng GD drafted the work or revising it critically for important intellectual content; all authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; and All authors made final approval of the version to be published.
Informed consent statement: The patient was informed that data concerning the case would be submitted for publication and gave his consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Dong Feng, MD, Associate Chief Physician, Associate Professor, Doctor, Surgeon, Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China. ok_surgeon@163.com
Received: November 8, 2021
Peer-review started: November 8, 2021
First decision: February 7, 2022
Revised: March 3, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 26, 2022
Processing time: 197 Days and 10.2 Hours
Abstract
BACKGROUND

Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.

CASE SUMMARY

A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up.

CONCLUSION

After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.

Keywords: Postoperative infection; Lateral skull base; Suppurative parotitis; Vacuum sealing drainage; Two-stage surgery; Case report

Core Tip: This is a case report of a 30-year-old male patient with a left jugular foramen paraganglioma who underwent first-stage surgical resection of the epidural portion of the tumor. On postoperative day 25, he developed fever, swelling, and tenderness under the left ear. Investigation and retrospective analyses revealed an infection of the skull base surgical site caused by pseudomonas aeruginosa, due to postoperative suppurative parotitis. The infection was successfully treated with vacuum sealing drainage and antibiotic therapy. The second-stage operation took place 6 mo later, and tumor recurrence was not detected after a 6-month follow-up.