Intraorbital abscess: A rare complication after maxillary molar extraction

doi:10.14219/jada.archive.2005.0293

The Journal of the American Dental Association

Volume 136, Issue 7, July 2005, Pages 921-925

https://doi.org/10.14219/jada.archive.2005.0293 Get rights and content

ABSTRACT

Background

The orbit is prone to being affected by an odontogenous infection, owing to its anatomical proximity to the maxillary sinus. A possible reason for an ophthalmic manifestation of a dental abscess is extraction of an acutely inflamed tooth.

Case Description

The authors describe the treatment of a man who had painful swelling and redness in the area of his right eye after having a maxillary molar extracted a few days previous. A general dentist referred the patient to the clinic after he began to experience a progressive deterioration of vision of his right eye. Emergency surgical intervention prevented impending loss of vision, and subsequent healing was uneventful.

Clinical Implications

To avoid serious complications, clinicians should not perform a tooth extraction when the patient is in the acute stage of a maxillary sinus infection. Appropriate diagnostic imaging and profound evaluation of the clinical state play major roles in managing the treatment of patients with inflammatory processes that involve the oral and paraoral regions.

Section snippets

CASE REPORT

A 20-year-old man complained of massive swelling and redness in the area of his right eye. The swelling and redness had worsened over the previous two days and become critical in the past few hours (Figure 1). The reason he came to the University Clinic for Reconstructive Surgery (Department of Cranio- and Maxillofacial Surgery, University Hospital, Basle, Switzerland) was that he was experiencing a progressive deterioration of vision in his right eye. Clinically, we observed a swollen,

DISCUSSION

The cause and diagnosis of serious odontogenic infections and their tendency to spread has been described extensively in the literature.6, 7, 8 The anatomical proximity of the root apexes to the surrounding soft tissues favors pathogen transmission into the periodontal ligament,⁹ since pathogens will take the path of least resistance.¹⁰ Dental infections that spread beyond the tooth socket can initiate an infection in adjacent muscles and in connective tissue structures. According to this

CONCLUSIONS

A severe and sometimes life-threatening infection with abscess formation in surrounding tissue structures can occur if a tooth extraction is performed when the patient is in the acute stage of a maxillary sinus infection. Therefore, it is essential that general dentists be aware of the possible ways odontogenous infections can spread and that they know how to manage such complications in the case of emergency.

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Retrobulbar abscess: rare complication after repair of an oroantral communication
2018, British Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
It is a rare emergency that could lead to loss of vision, and has been associated with retrobulbar haemorrhage after injury to, or operation on, the globe. Although orbital abscesses have been reported in relation to chronic paranasal sinusitis,5 facial injury,6 odontogenic infections,7 and after dental extractions,8 there are, to the best of our knowledge, no previously reported cases secondary to repair of an oroantral communication. This case highlights the importance of early clinical and radiological assessment to facilitate urgent surgical decompression and prevent the risk of blindness.
We present the case of a retrobulbar abscess that developed secondary to the repair of an oroantral communication. Orbital abscesses have been described in relation to odontogenic infections, facial injury, sinusitis, and after dental extractions but, to the best of our knowledge, none has been reported in these circumstances. Retrobulbar abscess is a rare complication, but early clinical and radiological diagnosis, and urgent decompression are vital because it comes with considerable risk of irreversible visual impairment.
Orbital abscess during endodontic treatment: A case report
2012, Journal of Endodontics
Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature.
The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region.
The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation.
Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease.
Imaging Studies for Head and Neck Infections
2007, Infectious Disease Clinics of North America
Citation Excerpt :
Extension of infection from maxillary dentition may involve the maxillary antra, presenting with sinusitis, or the parotid gland, with associated painful mass. Orbital involvement has been reported through various routes, including maxillary sinus, premalar soft tissues, pterygopalatine fossa, inferior orbital fissure, or facial, angular, and ophthalmic veins [24]. The infected tooth usually requires extraction to achieve resolution, and its recognition may be delayed without an early CT examination [25].
Imaging the head and neck presents a unique challenge because of the dense concentration of complex anatomy and the importance of lesion localization in formulating the differential diagnosis and prognosis. Critical imaging features such as the ability to define fascial borders of soft tissue neck compartments, the demonstration of intricate anatomy such as the temporal bones and paranasal sinuses, and the noninvasive assessment of vascular integrity have improved greatly in recent years in parallel with the rapid technologic advances in multidetector CT and MRI. After comparing the available imaging techniques, this article explores the imaging findings by anatomic region.
Knowledge of ocular infections among the dental practitioners across India: a cross sectional survey
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¹: Dr. Stübinger is a dentist, University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital, Spitalstr. 21, CH-4031 Basle, Switzerland

²: Dr. Leiggener is an oral and maxillofacial surgeon, University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital, Basle, Switzerland.

³: Dr. Sader is an oral and maxillofacial surgeon, University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital, Basle, Switzerland.

⁴: Dr. Kunz is an oral and maxillofacial surgeon, University Clinic for Reconstructive Surgery, Department of Cranio- and Maxillofacial Surgery, University Hospital, Basle, Switzerland.

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Case ReportIntraorbital abscess: A rare complication after maxillary molar extraction

ABSTRACT

Background

Case Description

Clinical Implications

Section snippets

CASE REPORT

DISCUSSION

CONCLUSIONS

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

JADA

Auris Nasus Larynx

Br J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Craniomaxillofac Surg

Weichteilinfektionen

Orbital abscess: management and outcome

Indian J Ophthalmol

Brain abscesses caused by oral infection

Endod Dent Traumatol

Case Report
Intraorbital abscess: A rare complication after maxillary molar extraction