2010 Copyright @ Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. Luc’s Abscess: The Return of an Old Fellow *Inbal Weiss, *Tal Marom, *Abraham Goldfarb, and *†Yehudah Roth *Department of OtolaryngologyYHead and Neck Surgery, Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel; and ÞDalla Lana School of Public Health, University of Toronto, Ontario, Canada Objective: Mastoiditis, subperiosteal abscess and sigmoid vein thrombosis are the most common suppurative complications of acute otitis media (AOM). Luc’s abscess, a subperiosteal tem- poral collection, is an infrequent complication with a particu- larly benign course. Patients: Two children, aged 5 years, presented with AOM complicated by an atypical abscess deep to the temporalis muscle, with no evidence for mastoid or zygomatic arch involvement. Intervention(s): Computed tomographic scan was performed in only 1 child. In both children, treatment included antibiotic therapy, grommet insertion, and local surgical drainage of the temporalis abscess. In addition, a cortical mastoidectomy was performed in the patient who did not undergo computed tomog- raphy, based on clinical assessment. Main Outcome Measure(s): Clinical improvement, resolution of symptoms. Results: Both patients recovered shortly following the surgical drainage. Mastoidectomy was poor in findings and was con- cluded as redundant. Conclusion: Luc’s abscess is associated with relatively little morbidity and requires a more limited surgical intervention. Computed tomographic scan is of great value to evaluate the extent of the disease and prevent needless mastoidectomy. Key Words: Acute otitis mediaVComplicationVComputed tomographic scanVTemporalis muscleVZygomatic arch. Otol Neurotol 00:00Y00, 2010. Acute otitis media (AOM) is a common disease in the pediatric population, which is usually treated with anti- biotics, with or without myringotomy (1). When compared with the pre-antibiotic era, suppurative complications of AOM are rare. Mastoiditis, subperiosteal abscess, and sigmoid vein thrombosis are the most common suppurative complications of AOM (2), whereas other suppurative complications, such as Bezold’s abscess or zygomatic arch abscess, are even less frequent. Luc’s abscess is another rare, yet benign, complication of AOM, which reflects a purulent collection deep to the temporalis muscle. This report describes 2 children who presented with an abscess deep to the temporalis muscle as a complication of AOM. We discuss the possible pathophysiology for the evolve- ment of this abscess, the recommended management, and treatment options. CASE PRESENTATIONS Case I A 5-year-old boy presented with a 2-day onset of a right temporal region swelling. Medical history was remarkable for recurrent otitis media. A week before admission to our department, he was diagnosed elsewhere with right AOM and was treated with oral amoxicillin for 5 days. A day before admission, he was examined because of a right temporomandibular joint (TMJ) pain and periauricular swelling. Otoscopy demonstrated mid- dle ear effusion (MEE); the auricle did not protrude, and there was a mild TMJ swelling, without fluctuation or tenderness. He was diagnosed with a TMJ inflammation, and treatment was switched to ibuprofen. A day later, on admission, he presented with a worsening of the swelling of right temporal region, a downward protrusion of the auricle, a retro-auricular erythema, and an ipsilateral cer- vical lymphadenopathy. Otoscopy demonstrated remnants of MEE. There was a mild protrusion of the anterosupe- rior external canal skin, without trismus or facial nerve involvement. Body temperature was 37.7-C. Laboratory workup revealed leukocytosis (26,200) with neutrophilia Address correspondence and reprint requests to Tal Marom, M.D., Department of OtolaryngologyYHead and Neck Surgery, Edith Wolfson Medical Center, P.O. Box 5, 58100 Holon, Israel; E-mail: maromtal@ 013.net.il Otology & Neurotology 00:00Y00 Ó 2010, Otology & Neurotology, Inc. 1