Rare since the use of antibiotics. Triad combining acute otitis media (with or without purulent otorrhea), retroorbital facial  pain (territory of the V1 and V2 branches of the V nerve ) and a homolateral facial nerve palsy (external oculomotor palsy). This complication of otitis seems due to osteitis and arachnoiditis localized at the tip of the petrosal bone following the spread of infection in the air cells of the mastoid. One can also observe cavernous sinus thrombosis or localized carotid arteritis. Treatment consists of broad spectrum antibiotics, and, in case of vascular thrombosis, LMWH-based anticoagulation for 3 months at curative doses. A mastoidectomy is needed in case of failure of the medical treatment.

Anesthetic implications: 

exclude the presence of a cause of intracranial hypertension (tumour, infection); check the hemostasis in case of anticoagulation.

References : 

-         Marteau E, Georget-Bouquinet E, Verlhac S, Gauthier A, Remus N, Madhi F. 
Successful prolonged conservative treatment of Gradenigo’s syndrome in a 4-year-old girl: a case report and review of the literature. 
Int J Pediatr Otorhinolar Extra 2011; 6: 100-3.

-        Favier M, Bessou P, Franco-Vidal V, Pédespan J-M. 
Syndrome de Gradenigo au cours d’une apicite chez un enfant. 
Arch Pédiatr 2015 ; 22 : 283-6.

Updated: April 2019