Odontogenic Orbital Cellulitis Research Articles

Odontogenic orbital cellulitis: literature review

Introduction: Odontogenic origin is a rare cause (1.3–5%) of cases of orbital cellulitis, but it can lead to very important morbidity such as blindness or thrombosis of the cavernous sinus. It is therefore important to know how to recognize it. Methods: A literature review was performed. The parameters analyzed included age, sex, ethnicity, clinical presentation, imaging to determine orbital involvement, etiology, microbiology, treatment (medical and/or surgical), and final outcome of each case. Chandler's classification was used to classify the different types of cellulitis. Results: Thirty-five cases of odontogenic orbital cellulitis have been described in literature from 1980 to 2022. In 42.9% of cases, the cellulitis corresponded to an intra-orbital abscess (Chandler stage IV). Thrombosis of the cavernous sinus (stage V) was detected in 5.7% of cases. Periorbital edema (100%), ocular or facial pain (82.9%) and limitation of eye movements (82.9%) were the three most common ophthalmological signs. The anamnesis revealed an element pointing to a dental origin in 97.1% of the cases, the two most frequent being a dental avulsion (20%) or an endodontic treatment (14.3%), in days or weeks preceding the onset of symptoms. Imaging was performed on admission in 94.3% of cases. Regarding the most frequently encountered germs, commensal streptococcus of the oral cavity or anaerobic bacteria were found in 25.7% of cases, and coagulase-negative staphylococcus in 22.9% of cases. In 94.3% of cases, broad-spectrum intravenous antibiotic therapy was initiated as soon as the diagnosis was made. The common feature was the use of metronidazole in 51.4% of cases, combined with a third-generation cephalosporin (11.4%) or amoxicillin-clavulanic acid (8.6%). Orbital drainage was necessary in 71.4% of cases to allow resolution of symptoms, associated with drainage of the maxillary sinus in 45.7% of cases. Finally, the treatment allowed a recovery without sequelae in 80% of cases. Discussion: In case of suspected orbital cellulitis, imaging is crucial to confirm the diagnosis, the type of cellulitis and plan the appropriate surgical treatment. The first step of treatment will be the quick start of a broad spectrum intravenous antibiotic therapy, targeting aerobic and anaerobic bacteria. However, it seems imperative to associate a surgical treatment consisting in a first step of an oral drainage and an elimination of the oral infectious source, as well as an orbital drainage whose approach will have been determined by the imaging. Conclusion: Orbital cellulitis is a rare complication of oral cavity infections, but it must be recognized and treated in time to avoid serious morbidity. An early medical and surgical treatment will usually allow good results and a healing process without sequelae.

Blindness Secondary to Odontogenic Infections: Case Series from a Tertiary Health Care Facility in Sokoto, Northwestern Nigeria

Blindness secondary to odontogenic orbital infection is not uncommon. We report five (5) cases of severe odontogenic orbital cellulitis causing blindness. These patients were seen and managed over a 3-year study period (from July 2019 to August 2022) at the Dental and Maxillofacial surgery clinic of Usmanu Danfodiyo University Teaching Hospital Sokoto. There were 2 male children and a female child in the age range of 6-10years with a mean±SD of 7.7±2.1, a 37-year-old male and a 24-year-old female. Cancrum oris/osteomyelitis was the primary diagnosis in one child, right maxillary osteomyelitis in two children, buccal +temporal space abscess and buccal space abscess in the two adult (male and female) patients respectively. All patients had a preceding history of toothache before the onset of other symptoms. All the patients had visual acuity of no light perception in the affected eye. Additionally, they had a varying degree of proptosis and restricted ocular motility while one child presented with purulent discharge and disorganized globe. Aggressive medical and surgical treatment was instituted in consultation with the ophthalmologists, which resulted in the resolution of the disease in all the patients.

Pain management in a child with odontogenic orbital cellulitis and severe complications

Introduction. Orbital cellulitis is a diffuse purulent inflammation of the orbital tissues followed by necrosis. Complications of orbital cellulitis include meningitis or cerebral vascular thrombosis leading to death.Background. We present the case of a 3-year-old child with orbital cellulitis and severe complications treated at the Departmentof Anesthesiology and Intensive Care, CNE “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”.Results. The child presented to the ophthalmology department with complaints of pronounced lid edema and hyperemia, right eye exophthalmos, massive purulent, foul-smelling discharge from the right eye, hyphema of the inner and outer corners of the eye, absent movements of the right eyeball, hyperthermia. Non-contrast computed tomography of the brain revealed osteomyelitis of the right maxilla, cellulitis of the right orbit, right-sided sinusitis, ethmoiditis. Under general anesthesia, there were performed deep orbitotomy, extraction of teeth 54, 55 with the extraction area drainage, puncture of the right maxillary sinus. Multimodal analgesia, detoxification therapy, empiric antimicrobial therapy, immune replacement therapy, protein replacement therapy, and syndromic treatment were chosen. On the 9th day, the child’s condition improved, and he was transferred to the ophthalmology department. On the 27th day of hospital stay, the child was discharged home in a satisfactory condition.Conclusions. The child’s recovery was achieved due to timely hospitalization and surgery, goal-directed antibiotic therapy, application of multimodal anesthesia principles and adequate pain management, immune replacement therapy, usage of non-specific detoxification methods and adequate rehydration therapy.

A case report on loss of vision secondary to odontogenic orbital cellulitis

We report a rare case of complete loss of vision secondary to odontogenic orbital cellulitis. A 54 years old female presented with 3 days history of left sided periorbital swelling and nasal discharge complaining of increasing facial pain. She was diagnosed with orbital cellulitis and treated empirically with intravenous antibiotic. Despite initial medical treatment, symptoms worsened leading to loss of vision. Indirect fundoscopy confirmed a left central retinal artery occlusion. An urgent CT revealed left maxillary sinus opacification with diffuse periorbital oedema, proptosis and no drainable orbital collection. She underwent Lynch Howarth procedure to reduce the orbital pressure. Ischaemic optic neuropathy and central retinal artery occlusion secondary to tension orbit odontogenic orbital cellulitis with no orbital collection are rare. We propose by serial intraocular measurements and maintaining the pressure below 21 mmHg with topical and systemic treatments, the risk of visual loss in patients presenting with similar pathology can be reduced.

Blindness Secondary to Odontogenic Orbital Cellulitis During the COVID-19 Dental Shutdown.

A 65-year-old man with history of right amblyopia presented with 2 weeks of oral pain leading to progressive midface and eyelid swelling, then 2 days of left eye vision loss. One-week prior, his dentist prescribed oral antibiotics after a telephone consultation; in person, dental examination was not performed due to COVID-19 ordinances. On presentation, visual acuity was 20/400 and no light perception, and intraocular pressures were 14 and 23, in the right and left eyes, respectively. Extraocular motility was severely restricted in all directions bilaterally. External examination demonstrated bilateral eyelid and midface erythema, edema, and desquamation overlying congested orbits (Fig. 1A–C). Posterior segment examination revealed optic disc edema and chorioretinal folds in the right eye (Fig. 1D) and was normal in the left eye. CT maxillofacial demonstrated multifocal, bilateral orbitofacial abscesses, and midface abscesses of the upper alveolar origin (Fig. 2A). CT orbits demonstrated proptosis and tenting of the right globe (Fig. 2B) and left preseptal and postseptal abscesses (Fig. 2C). The patient underwent emergent bilateral orbit and facial abscess drainage. Cultures revealed polymicrobial organisms consistent with oral flora. Intravenous antibiotics further remedied the cellulitis, but visual acuity at 8 weeks of follow-up was 20/150 and no light perception in the right and left eyes, respectively. Optical coherence tomography demonstrated severe retinal nerve fiber layer thinning in the left eye consistent with optic atrophy. This case highlights an indirect ophthalmologic consequence of the COVID-19 pandemic and illustrates the perils of dental management without adequate assessment.FIG. 1.: External photographs demonstrating bilateral eyelid and midface erythema, edema, and desquamation (A) with bilateral bullous conjunctival chemosis and injection (B, C). Right eye fundus photograph demonstrating optic disc edema and chorioretinal folds (D).FIG. 2.: CT maxillofacial demonstrating bilateral orbital cellulitis with midface abscesses of upper alveolar origin (A), right globe tenting (B), and left pre- and post-septal abscesses (C).ACKNOWLEDGMENT We thank the patient for granting permission to publish this case.

Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature

Aims Odontogenic orbital cellulitis represents a complication of root infections of upper pre-molars and molars. The severity depends on the orbital structure involved. The treatment is based on antibiotic therapy associated or not to surgery. Through the presentation of three cases and a review of literature, we purpose as aim of our study to underline the necessity of a timely diagnosis and to provide the correct surgical approach in each different types and stages of orbital infections. Methods We present three patients that were affected by dental infection evolved in orbital cellulitis. In two cases the disease was solved with the extraction of infected tooth and a surgical endoscopic drainage of the abscess through antrostomy of maxillary sinus. In the third patient the disease had already induced a bulbar perforation and endophthalmitis, so an orbit evisceration was necessary. Results Review of literature showed that the standard treatment of orbital cellulitis is the transnasal approach associated or not by a transoral and/or transcutaneous procedure depending on the stage of the disease and on the causes. In our 3 cases these indications were followed without relapses of the disease. Conclusion An early diagnosis is mandatory in odontogenic orbital cellulitis specially to avoid serious complications. Surgical treatment can be simple and effective mostly in early-stage infection: it is based on extraction of infected tooth and on the drainage of abscess. Surgical approach consists in transnasal procedure flanked or not by transoral and transcutaneous procedures based on the stage of the infection considering involved structures.

Odontogenic orbital cellulitis. Case report and review of literature

Odontogenic orbital cellulitis. Case report and review of literature

Odontogenic orbital inflammation

Objective: This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. Material and Methods: This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. Results: All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Conclusions: Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. Abbreviations: CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.

Odontogenic orbital cellulitis in a young man with complete vision loss – a case report

Abstract Odontogenic inflammation in humans can spread to adjacent anatomical structures, causing pathological changes that are dangerous to health and, in some cases, life. In this paper, we present an unusual case of odontogenic orbital cellulitis caused by both Lactobacillus rhamnosus and Enterococcus avium, which resulted in blindness of the eye in a 25-year-old man. Orbital cellulitis is more common in children due to the relative immaturity of their immune systems whereas it is rare in adults – in most cases, it occurs as a complication of paranasal sinusitis. An accurate diagnosis requires not only a thorough clinical examination but also appropriate imaging tests (such as a computed tomography or nuclear magnetic resonance test). Successful treatment largely depends on the earliest possible implementation of pharmacological therapy. In cases where it is justified, surgical procedures to decompress and drain the abscess should also be considered. However, in the case described in this publication, the patient did not regain vision in the affected eye despite the implementation of both intensive pharmacological treatment and surgical treatment, probably due to ischemic optic neuropathy and central retinal artery occlusion caused by severe infraorbital oedema.

Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report

BackgroundThis case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis.Case presentationA 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis. Hematochemical and radiological examinations confirmed the cavernous sinus thrombosis and also showed septic pulmonary embolism. A blood culture indicated Streptococcus constellatus, which is a member of the Peptostreptococcus family, a saprophyte of the oral mucosa that can be pathogenic in immunocompromised persons. The odontogenic origin was then confirmed by dental radiography which showed a maxillary abscess. Her eye signs regressed after antibiotic and anticoagulant therapy.ConclusionsThis complex case shows the importance of a multidisciplinary approach for the management of orbital cellulitis, for the prompt diagnosis and treatment of eye injuries and possible complications, so as to avoid serious and permanent sequelae.

Odontogenic orbital cellulitis causing blindness: A case report

Blindness secondary to odontogenic orbital cellulitis is a rarity. We report a case of a 38-year-old man who presented with facial swelling and orbital pain. Examination revealed right orbital purulent discharge, nil light perception in the right eye and the presence of a grossly carious ipsilateral maxillary molar. Investigations revealed no underlying systemic condition. Aggressive surgical and medical intervention was instituted, which resulted in disease resolution. However, vision in the right eye was not recovered. Dental infections may lead to blindness; therefore, dental infections should be promptly treated.

Orbital Cellulitis of Odontogenic Origin

Odontogenic orbital cellulitis, although uncommon, has the potential to cause severe vision loss if unsuspected and untreated. Compared to non-odontogenic bacteriology, odontogenic orbital abscesses typically feature a heavy mixed growth with anaerobic organisms. We review the literature and discuss the case of a 26-year-old male who presented with anaerobic orbital cellulitis for treatment.

A Case of Odontogenic Orbital Cellulitis Causing Blindness: A Case Report

Aim: To report a case of odontogenic orbital cellulitis causing blindness in young male Methods: We report a rare case of odontogenic orbital cellulitis secondary to periodontal abscess, due to which a young male lost his sight. Results: After extensive clinical examination and investigations diagnosis of odontogenic orbital cellulitis. Patient took incomplete treatment and showed negligence while taking treatment for recurrent periodontal abscess. As a result he developed orbital cellulitis and temporal fossa abscess, which ultimately caused blindness in his right eye. Discussion: Orbital Cellulitis is the infection of the soft tissues behind the orbital septum. Orbital cellulitis is a life threatening infection. It is an ocular emergency that not only threatens vision but also can lead to life-threatening complications such as cavernous sinus thrombosis, meningitis, and brain abscess. The major causes of orbital cellulitis are sinusitis (58%), lid or face infection (28%), foreign body (11%), and hematogenous (4%), odontogenic 2-5%. Odontogenic i.e tooth related causes of orbital cellulitis are very less.

Odontogenic Infection Causing Orbital Cellulitis in a Pediatric Patient

Odontogenic abscess can become an orbital cellulitis, causing potentially serious intracranial and orbital complications. The full clinical complications from odontogenic orbital cellulitis in a pediatric patient are rarely seen daily in hospital emergency departments. Thus, odontogenic orbital cellulitis still remains a rarity, resulting in a medical challenge. With this in mind, this study aimed to describe a case of periorbital and orbital cellulitis resulting from odontogenic origin in a 6-year-old patient who was successfully treated by performing intravenous antibiotic administration combined with surgical drainage.

A Case of Odontogenic Orbital Cellulitis Causing Blindness by Severe Tension Orbit

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.

UNCONTROLLED DIABETES MELLITUS

Although there are many causes of orbital cellulitis and odontogenic orbital cellulitis is a rare entity but it is quite commonin patients with uncontrolled diabetes. We present small series of patients with odontogenic orbital cellulitis and review the devastating visualoutcome in patients with uncontrolled diabetes. Purpose of this report is to highlight the significance of ocular complications of dentalinfections which if not tackled promptly can lead to blindness especially if the patient is an uncontrolled diabetic. This case series alsostresses upon the importance of dental hygiene and the proper sterilization of the dental surgical instruments which is not given dueconsideration in the developing countries like Pakistan.

Odontogenic Orbital Cellulitis

To describe a small series of patients with odontogenic orbital cellulitis and review the visual outcomes of such patients reported in the scientific literature. Review of medical records and the scientific literature. Measured parameters included gender, age, days to presentation and surgery, the need for surgical intervention(s), sinus and orbital involvement on CT imaging, and pathogens involved. Current cases and review of the scientific literature resulted in 24 patients with odontogenic orbital cellulitis and adequate examinations for statistical analysis. Twelve of 24 patients had preserved vision (final vision better than 20/70), whereas 11 of 24 patients had vision loss (final vision of light perception or no light perception). Analysis of data showed no statistical correlation between visual loss and age (p = 0.81), days to clinical presentation (p = 0.45), days to surgical exploration (p = 0.96), sinus radiographic involvement (p = 0.50), orbital radiographic findings (p = 0.19), or type of bacterial infection (Gram-positive aerobic vs. anaerobic organisms), (p = 0.31 and p = 0.50 respectively). Male gender, the need for surgical drainage, and multiple surgical procedures performed correlated statistically with loss of vision (p = 0.05, p = 0.03, and p = 0.02, respectively). Multiple case reports have demonstrated that orbital cellulitis from an odontogenic source can result in devastating visual loss. Male gender, the need for surgical drainage, and multiple surgical procedures correlated statistically with severity of visual loss.

Odontogenic Orbital Inflammation: Clinical and CT Findings—Initial Observations

To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection. Approval from the institutional review board was obtained for chart and scan review, and informed consent was waived for this HIPAA-compliant study. Five patients, two male and three female (median age, 37 years; age range, 13-55 years), who had odontogenic orbital cellulitis underwent clinical evaluation, CT scanning, and treatment. CT findings, including periapical lucency suggesting abscess, sinus opacification, and the route of spread of infection, were analyzed in each patient. Imaging, clinical, and surgical findings, including the initial clinical diagnosis and the presence of a periapical abscess at surgery and at pathologic examination, were compared. Periapical lucency and sinus opacification were seen in all patients. The route of infection spread was through either the premalar soft tissues or the maxillary sinuses. The odontogenic origin of the orbital infection was not clinically suspected in any patients. Correct diagnosis was later made at CT in all patients. Four patients had periapical abscesses at pathologic analysis, and the fifth patient had apical periodontitis at clinical analysis and granuloma at pathologic analysis. Dental surgery was required in each of the five patients for resolution of infection; four patients underwent extraction of the infected tooth, and one patient underwent incision and drainage of a periapical abscess. Abnormal periapical lucency, widening of the periodontal ligament space, and the presence of a subperiosteal abscess suggested an odontogenic origin of orbital infection.