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Clinical Problem Solving: Radiology
June 2003

Radiology Quiz Case—Diagnosis

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Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Otolaryngol Head Neck Surg. 2003;129(6):684. doi:10.1001/archotol.129.6.683

In November 1881, Friedrich Bezold described a coalescent mastoiditis with pus escaping through the incisura digastrica, forming an abscess spreading along the digastric muscle toward the chin, filling the retromandibular fossa, and/or spreading further along the sternocleidomastoid, trapezius, and splenius muscles, a condition that was fatal when the vertebrae and skull base were affected.13 In the preantibiotic days of Bezold, otitis media acuta was complicated by mastoiditis in 50% of cases, 20% of which involved a Bezold abscess. Since the advent of modern antibiotic therapy, acute mastoiditis occurs in only 0.24% of cases of acute otitis media and leads to abscess formation in 50% of these cases. So even though mastoidal complications of otitis media are rare today, they are more often followed by extramastoidal complications.4

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