Cranial osteomyelitis 7 years after orbital exenteration and orbital implants: A cascade of problems with a good final outcome

Abstract Cranial osteomyelitis is an uncommon, but important entity, particularly when misdiagnosed. This case report describes a 73-year-old woman with a history of basal cell carcinoma in her right eyebrow. After treatment with surgery and radiotherapy, two years later, she had undergone another operation for reconstruction and orbital implants. The present study describes imaging aspects, treatment options, and follow-up of an incident that occurred seven years after reconstruction. The patient visited the emergency department, due to a deep infection around the orbital implants. We detected early cranial osteomyelitis, but treatment was followed by a cascade of problems. After two months, she presented with exposed osteosynthesis material. Two months after removal of the material, she was diagnosed with supraorbital osteoradionecrosis. Subsequent treatment with antibiotics, debridement, and a transposition flap provided a successful final outcome.