A Bezold abscess is a complication of acute otomastoiditis where the infection erodes through the cortex medial to the attachment of sternocleidomastoid, at the. Currently. as a result of the use of antibiotics to treat mastoiditis, Bezold's abscesses and other complications of mastoiditis are rare. Because these abscesses. Bezold Abscess is a rare deep neck abscess resulting from an intertemporal complication of a coalescent mastoiditis. It was first described by a  ‎Introduction · ‎Pathophysiology · ‎History and Physical · ‎Treatment / Management.


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The pressure created by this purulent material with its enzymatic bezold abscess within the mastoid bezold abscess causes osteitis and osteonecrosis of the fragile pneumatized air cells further thinning the walls of the mastoid bone.

This stage is Coalescent Mastoiditis.

Modern Presentations of Bezold's Abscess | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network

The inflammatory process bezold abscess spread in many directions. Bezold abscess it spreads inferiorly towards the mastoid tip, the purulent material will eventually erode the very thin bone along the digastric ridge at the insertion of the digastric muscle.

Consequently, a purulent material will spread into the neck between the digastric and sternocleidomastoid muscles. Both may have had a history of recurrent otitis media or chronic otitis media with tympanic membrane bezold abscess and a draining ear.

Prior mastoid surgery for cholesteatoma normally causes further thinning of the mastoid walls making it easier for infection to spread.

Bezold's abscess - Wikipedia

An important early clinical sign of a coalescent mastoiditis on physical examination is sagging of the posterior superior external auditory canal. Bezold abscess common clinical signs include the following: If any of the bezold abscess are documented, and the patient presents with fever with an associated neck mass one should have a high index of suspicion that the bezold abscess has spread to adjacent regions within the head and neck.

Thus a thorough head and neck evaluation should always be conducted. In the differential diagnosis, one must always consider an abscess of post-auricular lymph nodes.

If CT scanning is not available, then bezold abscess simple lateral x-ray of the temporal bone may be helpful in ascertaining the status of the mastoid air cell system. Evaluation Laboratory evaluations are often not helpful, since the leukocyte count and erythrocyte sedimentation rate may bezold abscess normal.

  • Abscess, Bezold - StatPearls - NCBI Bookshelf
  • Bezold abscess | Radiology Reference Article |
  • Bezold's abscess: A rare complication of acute otitis media
  • Modern Presentations of Bezold's Abscess

Contrast computed tomography should be obtained if there is any indication or suspicion of a deep neck abscess, regardless of a bezold abscess of evidence of an infection in the mastoid bone since prior antibiotics may have truncated the infection in the mastoid bone while the abscess was still developing in the neck.

An intravenous contrast CT scan was used to confirm the ultrasound findings, and both an abscess bezold abscess the neck and ear pathology were identified. Once antibiotic therapy is initiated, a contrast CT scan should be obtained.

Bezold's abscess

Naturally, cultures are important, particularly if you are dealing with a diabetic or immunocompromised patient since the bacteriology in these case may be different.

If surgical management is indicated, in adults, a post-auricular incision is made, and a simple, complete mastoidectomy should be performed.

The objective is to remove as much osteitic bone and bezold abscess tissue present in the mastoid bone. In rare cases, a Bezold abscess may appear in children before there is a complete development of the mastoid air cell system.

In these bezold abscess, the practitioner must pay particular attention to the position of the facial nerve. On day 9, the patient was discharged on oral antibiotics for two weeks. A month later on follow-up, the patient was clinically well with good wound healing.

The left facial nerve palsy improved bezold abscess grade III. The left ear and mastoid cavity were dry.

Discussion Friedrich Bezold —a German otologist first described Bezold's abscess in patients with acute otitis media. The pus may spread along the digastric muscle to the chin, filling the retromaxillary fossa, and along the course of the occipital artery. If left untreated, further bezold abscess extension may occur due to resistance to direct extension by the sternocleidomastoid, trapezius and splenius muscles.

The pus may track along these muscles and if it reaches the deep muscles of the neck, it might extend to the transverse processes of the vertebrae as low as the second thoracic vertebrae. In this case, the patient initially presented with left ear discharge.

However, he only sought medical treatment when he developed fever and a painful left upper neck swelling. It is important to note bezold abscess association of neck abscesses with otitis media in this case and tie the diagnosis together, as it could have easily been misjudged as being two separate pathologies.


Radiological examination, especially CT scan of the mastoid and neck is bezold abscess useful in establishing the diagnosis. Gaffney suggested that CT scan should be done in every case of otitis media with neck swelling, because of the variable routes pus can spread within the neck.

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