A Bezold's abscess is an organized collection of pus located deeply in the neck, in the sternocleidomastoid muscle and the infratemporal fossa. It occurs as a complication of otomastoiditis.
A Bezold's abscess occurs as a complication of acute otomastoiditis and is currently an uncommon medical condition, due to the advent of antibiotics. It develops when suppuration products escape through the mastoid process (medial side) at the digastric fossa . The initial site where the abscess can be formed is the chin, and can then progress to an abscess formation in the sternocleidomastoid, splenius or trapezius muscles.
Due to its location being deep in the cervical muscles, a Bezold's abscess may not always present as a palpable mass and it is frequently misdiagnosed. A typical presentation involves symptoms related to an otitis media complicated by mastoiditis, such as otalgia, otorrhea, post auricular pain or fever. Neck pain is frequent and in some cases, a mass can be palpated or seen either on the chin, or at some part of the course of the sternocleidomastoid muscle. Hearing loss may also complicate the clinical picture, accompanied by enlarged cervical lymph nodes, facial paralysis, and cephalalgia.
Due to the difficulties in assessing and diagnosing a Bezold's abscess, the condition may develop over even years, before it is diagnosed. A case study presented the possibility of a Bezold's abscess manifesting without a prior history of ear suppuration, with the symptoms being tinnitus, torticollis, fever, postauricular swelling and periodic pain in the region of the mastoid . A patient presenting solely with a medical history of an ear infection and a cervical mass is also a potential clinical manifestation . Prior to the advent of antimicrobial drugs, a Bezold's abscess could extend to the spinal cord, causing compression, coma, and death . This clinical picture is not to be seen today, given that the patient receives standard medical care.
The first step towards a successful diagnosis is a thorough medical history. Any patient that reports a prior otitis media, postauricular pain, otorrhea and cervical pain should be suspected of suffering from Bezold's abscess. A history of an untreated otitis or mastoiditis should raise suspicion.
Imaging modalities such as a computed tomography scan (CT scan) or a magnetic resonance imaging scan (MRI scan) are those that can establish the diagnosis of a Bezold's abscess. A CT scan illustrates findings compatible with an inflammation of the mastoid and subsequent escape of pus. A middle ear and mastoid filled with fluid, alongside demineralized trabeculae and thickening of the skin in the area overlying the abscess, are typical findings  . The CT scan also helps to delineate the location and exclude its extension into the thoracic cavity or vertebra as well as to plan surgical strategy. An MRI scan can be used to confirm the diagnosis if the CT scan should yield negative results and it is also more effective in assessing cerebral damage induced by otitis media .