Osteomyelitis of the Odontoid Process: A Literature Review and Recommendations

Introduction: Odontoid osteomyelitis (OOM) is a rare clinical entity that requires a high degree of suspicion for diagnosis. A literature review was conducted to make recommendations for early diagnosis and best practices in the management of OOM. Materials and Methods: Literature review of all available articles, all of which were case studies or case series, published in PubMed and Google Scholar. Results: There were 47 articles published from 1944 to 2024 with n = 54 with confirmed diagnosis of OOM. The median age was 52 years and 64% were male. Likely precipitating factors were identified in 29 patients (54%). Neck pain was the most common presentation (87%), followed by fever (57%) and neck stiffness (44%). Neurological symptoms developed in 50% of patients. Magnetic resonance imaging (MRI) was frequently used (85%) with 72% of these indicating OOM. Staphylococcus aureus was the most common pathogen (82%). Surgery was performed in 59% of patients. Conclusion: To avoid delayed or misdiagnosis of this rare entity, a thorough history and physical should be performed to identify patient risk factors, salient complaints, and potential nidi of infection. MRI remains the gold standard in diagnosis. Early pathogen identification with appropriate antibiotics, and incision and drainage when possible, can treat OOM while avoiding surgery. However, surgery is indicated in cord compression secondary to atlantoaxial subluxation, a common and feared complication of OOM. Keywords: Osteomyelitis, odontoid process, dens, axis, endonasal surgery.