Osteomyelitis of the skull base involves a complex anatomy and requires multimodality management. Delayed diagnosis and treatment can lead to death. To emphasize the challenge of this condition, we underscore the difficulty distinguishing between skull base malignancy and skull base osteomyelitis. Signs of craniofacial osteomyelitis include (a) clinical symptoms of persistent discharge from the natural orifices and severe pain and (b) imaging evidence of osteolytic lesions. Empirical treatment with antibiotics should be started as soon as possible to minimize morbidity and mortality.

Keywords: Osteomyelitis, Temporal bone, Skull base