Objective: To report clinical, laboratory, and radiological manifestations of two infants with osteomyelitis of the odontoid process.
Background: Acute osteomyelitis is not uncommon in children. The major mechanism is hematogenic spread of infection. The long bones, most likely because of their unique blood circulation and anatomy, have a predilection for infection from bacteremia. Vertebral osteomyelitis is uncommon, and osteomyelitis of the Dens (odontoid process) has rarely been reported in the pediatric population.
Methods: The medical records of two infants diagnosed with Dens osteomyelitis were reviewed. Data regarding clinical, laboratory, and imaging studies were collected.
Results: Both infants had fever which resolved spontaneously prior to their admission. They were both non-toxic appearing with persistent neck stiffness and torticollis. White blood count and C-reactive protein were only mildly elevated in both cases. Blood cultures were negative. Magnetic resonance imaging (MRI) revealed the diagnosis in both cases.
Discussion: Osteomyelitis of the dens in adults has sometimes been hematogenous in origin, but the majority of cases resulted from direct extension from epidural abscess or parapharyngeal / retropharyngeal abscess. In children, there are only rare case reports of this entity. Osteomyelitis of the Dens is rare and poses danger of atlantoaxial dislocation and extension of the infection to the epidural space, if not promptly diagnosed and treated.
Conclusions: We report two cases of Dens osteomyelitis. These cases emphasize the need to consider C1-C2 osteomyelitis in differential diagnosis of neck stiffness and torticollis in infants, and highlight the usefulness of MRI in diagnosing this clinical condition.
