Child's Nervous System

, Volume 35, Issue 12, pp 2265–2272 | Cite as

Gradenigo’s syndrome with abscess of the petrous apex in pediatric patients: what is the best treatment?

  • Salvatore SavastaEmail author
  • Pietro Canzi
  • Federico Aprile
  • Alexandre Michev
  • Thomas Foiadelli
  • Marco Manfrin
  • Marco Benazzo
Case-Based Update



Gradenigo’s syndrome is defined by the classic clinical triad of ear discharge, trigeminal pain, and abducens nerve palsy. It has become a very rare nosological entity after the introduction of antibiotics, so that has been defined as the “forgotten syndrome.” However, the underlying pathological process (apical petrositis) still represents a life-threatening condition that shall be immediately recognized in order to address the patient to the proper therapy. The therapy itself may be an argument of discussion: on a historical background ruled by surgery, reports of successful conservative antibiotic treatment have risen in recent years.

Methods and Results

We reported a case of Gradenigo’s syndrome in a child with an abscess of the left petrous apex and initial involvement of the carotid artery. After multidisciplinary evaluation, we decided to encourage conservative treatment, until complete regression was observed.


The available literature of the last 10 years was reviewed, with particular attention to the presence of an apical abscess and the therapeutic approach. The principles of management with regard to conservative therapy versus surgical indications are therefore examined and discussed.


Abducens Apicitis Surgery Conservative Antibiotic 


Compliance with ethical standards

Conflict of interest

None of the authors has any conflict of interest to disclose.

Ethics statement

We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Written informed consent was obtained from the patient’s parents for publication of all clinical data, imaging, and pictures.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Clinic, IRCCS Policlinico “S. Matteo” FoundationUniversity of PaviaPaviaItaly
  2. 2.Department of Otorhinolaryngology, IRCCS Policlinico “S. Matteo” FoundationUniversity of PaviaPaviaItaly

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