Odontogenic, atypical skull-base osteomyelitis: diagnostic pitfalls and therapeutic insights—a case report and mini-review

Skull-base osteomyelitis (SBO) represents a potentially fatal infectious condition that poses significant diagnostic and therapeutic challenges. With demographic shifts toward an older population and rising prevalence of comorbidities, physicians are encountering this complex disease with greater frequency. Current clinical practice lacks standardized protocols for both initial diagnosis and subsequent monitoring of disease progression. The present case analysis aims to provide valuable insights to guide medical practitioners in developing individualized treatment strategies for affected patients. Magnetic resonance imaging techniques demonstrate superior sensitivity in identifying early-stage bone marrow edema and soft tissue diffusion abnormalities. Current clinical evidence indicates that comprehensive antibiotic therapy with adequate dosing, when combined with prompt surgical intervention (including drainage or debridement procedures) and adjunctive hyperbaric oxygen treatment, leads to substantially improved clinical outcomes. The implementation of evidence-based early diagnostic approaches, facilitated by multidisciplinary team collaboration, has been shown to minimize diagnostic errors and decrease the likelihood of disease recurrence. In cases involving patients presenting with persistent craniofacial pain or neurological deficits, clinicians should maintain a high vigilance regarding the possibility for this condition. The implementation of a comprehensive diagnostic and therapeutic protocol incorporating advanced imaging assessment, microbial identification, and multidisciplinary case review, along with structured long-term monitoring, has been recommended to optimize patient management and improve clinical treatment outcomes.