Background: Gradenigo syndrome is a rare presentation of acute petrositis characterized by medial otitis, retro-orbital pain and abducens nerve palsy (CN VI palsy) affecting the lateral rectus muscle (CN VI palsy), due to inflammation of this nerve at Dorello’s canal. Treatment usually consists of mastoidectomy, and antibiotics. Successful treatments with less aggressive interventions have occasionally been reported.
Case Report: We describe the clinical and radiological findings and the conservative management of a 14-year-old who developed Gradenigo syndrome as a complication of otitis media, with a favorable outcome.
Conclusions: Gradenigo syndrome has a characteristic clinical presentation and requires immediate therapeutic management due to potential fatal complications; however, conservative treatment can achieve a complete recovery without major surgery.

Keywords: Abducens nerve palsy, Gradenigo syndrome, Otitis Media, myringotomy, mastoidectomy