Abstract
Odontogenic infections are common and very often spread to potential spaces of head and neck. The spread of such infection to adjacent maxillary sinuses or distant sites such as the orbits are a rare occurrence and may develop periorbital and orbital cellulitis. Unfortunately once orbital cellulitis and subsequently orbital abscess develops it can give rise to serious complications such as complete blindness or even more serious and life-threatening situations as cavernous sinus thrombosis, intracranial abscess or even death. Two cases are presented to demonstrate the differences between the two conditions and the necessary management in either case. This article provides an insight into the clinical behaviour of orbital infections of odontogenic origin with contemporary diagnostic and treatment modalities that will help in reducing morbidity and mortality associated with these conditions.
Highlights
An abscess around the periapical region of teeth is the most widely recognized type of odontogenic infection which starts by contamination of the root canal with microorganisms that cross apical foramen and invade periapical tissues
Very rarely the distant spread of odontogenic infection may involve the orbit, having a variable clinical presentation that ranges from more confined preseptal cellulitis to more severe and potentially aggressive involvement in form of orbital cellulitis and orbital abscess
In the patient presented in case 1 with periorbital cellulitis, odontogenic infection close to the root summit of the maxillary teeth likely entered through the buccal cortices to the respective maxillary sinus and ascended upwards to involve the orbit
Summary
An abscess around the periapical region of teeth is the most widely recognized type of odontogenic infection which starts by contamination of the root canal with microorganisms that cross apical foramen and invade periapical tissues. The patient revealed that the swelling around the eye developed after severe toothache in the left upper jaw for which she took analgesics which provided temporary relief. The intraoral examination revealed a carious left maxillary first premolar which was tender on percussion associated with a draining sinus (Fig. 1B). MRI revealed ill-defined radiopacities involving the intraconal compartment and diffuse fatty strands in the intraconal and extraconal compartment with resultant proptosis of the right eye globe and facial soft tissue swelling around the right orbit (Fig. 2B). In the third-week the patient was normotensive and had an improved mouth opening (Fig. 3B and C). The patient had normal vision, unrestricted eye-movements and adequate mouth opening on follow up after one month (Fig. 5A and B)
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