Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review.

Objectives: Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic. Methods: A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included. Results: A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided. Conclusions: Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.

Cavernous sinus thrombosis with bilateral orbital vein involvement and diffuse ischemic retinopathy / Trombose do seio cavernoso com envolvimento bilateral das veias orbitais e retinopatia isquêmica difusa

ABSTRACT A 53-year-old man with a 3-day history of periorbital swelling and vision loss in the left eye was found to have septic cavernous sinus thrombosis with bilateral orbital vein involvement causing congestive orbitopathy. He was treated with an emergent canthotomy and cantholysis, intraocular pressure-lowering drops, antibiotics, anticoagulation, and serial examinations. Optical coherence tomography ultimately revealed diffuse ischemic destruction of both layers of the retina, which suggested occlusion of the ophthalmic artery or the short posterior ciliary arteries and central retinal artery without intracavernous internal carotid artery involvement. The patient remained without light perception in the left eye after treatment.

RESUMO Um homem de 53 anos, com história de 3 dias de edema periorbital e perda de visão no olho esquerdo, apresentou trombose séptica do seio cavernoso com envolvimento bilateral das veias orbitais, causando uma orbitopatia congestiva. O paciente foi tratado com uma cantotomia e cantólise de emergência, colírios para redução da pressão intraocular, antibióticos, anticoagulantes e exames seriados. A tomografia de coerência óptica finalmente demonstrou destruição isquêmica difusa de ambas as camadas da retina, sugerindo uma oclusão da artéria oftálmica ou das artérias ciliares posteriores curtas e da artéria retiniana central, com ausência de envolvimento do segmento intracavernoso da artéria carótida interna. O paciente permaneceu sem percepção luminosa no olho esquerdo.

Superior ophthalmic vein and cavernous sinus thrombosis associated with COVID-19: a case report / Trombose de veia oftálmica superior e seio cavernoso associada à COVID-19: relato de caso

ABSTRACT Cavernous sinus and superior ophthalmic vein thrombosis is a rare clinical condition, and little described in the literature. The clinical presentation is nonspecific and highly variable, and symptoms may include red eye, ophthalmoplegia, coma, and death. The main etiology results from infection of the paranasal sinuses. The final diagnosis must be made through imaging tests such as magnetic resonance imaging. We describe a case of cavernous sinus and superior ophthalmic vein thrombosis after COVID-19 infection in a 64-year-old patient with persistent ocular hyperemia and pain on eye movement. Ophthalmological examination showed preserved visual acuity, conjunctival hyperemia, dilation of episcleral vessels and retinal vascular tortuosity in the right eye. Magnetic resonance imaging confirmed the diagnosis. The association with the COVID-19 was raised, excluding other infectious causes. Enoxaparin and Warfarin were started with significant improvement in the ocular clinical presentation and maintenance of initial visual acuity after 12 months of follow-up.

RESUMO A trombose de seio cavernoso e veia oftálmica superior é uma condição clínica rara e pouco descrita na literatura. A apresentação clínica é inespecífica e altamente variável. Os sintomas podem incluir olho vermelho, oftalmoplegia, coma e morte. A etiologia principal resulta da infecção dos seios paranasais. O diagnóstico final deve ser efetuado por meio de exames de imagem, como ressonância magnética. Descrevemos um caso de trombose de seio cavernoso e veia oftálmica superior após COVID-19 em paciente de 64 anos e com quadro de hiperemia ocular persistente e dor à movimentação ocular. Ao exame oftalmológico, observou-se acuidade visual preservada, hiperemia conjuntival, dilatação de vasos episclerais e tortuosidade vascular retiniana em olho direito. A ressonância confirmou o diagnóstico. A associação com a COVID-19 foi levantada, excluindo-se demais causas infecciosas. Prescrevemos enoxaparina e varfarina, com melhora do quadro clínico ocular e manutenção da acuidade visual inicial após 12 meses de acompanhamento.

Bilateral cavernous sinus and left dural sigmoid sinus thrombosis associated with extreme exertion: a case report / Trombose bilateral do seio cavernoso e do seio sigmoide esquerdo associada a exercício extremo: relato de caso

ABSTRACT Septic cavernous sinus thrombosis is a rare but often debilitating and potentially fatal disease. We describe a case of bilateral orbital cellulitis with rapidly progressing cavernous sinus thrombosis and left sigmoidal sinus thrombosis in an immunocompetent 20-year-old military man who had undergone intensive physical training. The patient presented with rapid painful swollen left eye for 2 days. The examination results were gross proptosis with total ophthalmoplegia. He was treated with intravenous antibiotics and corticosteroid. At 1 week, visual acuity improved to 20/20 OU, with a normal intraocular pressure. There was a significant improvement in proptosis. The ocular motility of the right eye was fully restored, with slight residual ophthalmoplegia in the left eye. There was no residual illness or recurrence of illness at 3 months' follow-up.

RESUMO A trombose séptica do seio cavernoso é uma condição rara, mas frequentemente debilitante e potencialmente fatal. Descrevemos um caso de celulite orbital bilateral com progressão rápida para trombose do seio cavernoso e trombose do seio sigmoide esquerdo, em um militar imunocompetente de 20 anos de idade que havia sido submetido a treinamento físico intenso. O paciente apresentou um inchaço rápido e doloroso no olho esquerdo por 2 dias. Os resultados do exame foram proptose macroscópica com oftalmoplegia total. Ele foi tratado com antibióticos intravenosos e costicosteróide. Em 1 semana, a acuidade visual melhorou para 20/20, com pressão intraocular normal. Houve uma melhora significativa na proptose. A motilidade ocular do olho direito foi totalmente restaurada, com leve oftalmoplegia residual no olho esquerdo. Não houve doença residual ou recorrência da doença após três meses de acompanhamento.

Trombosis del seno cavernoso derecho secundaria a rinosinusitis esfenoidal: reporte de caso / Right cavernous sinus thrombosis secondary to sphenoidal rhinosinusitis: case report

RESUMEN La rinosinusitis bacteriana aguda es la infección de la mucosa nasal y de senos paranasales, que se manifiesta con congestión nasal, rinorrea purulenta y fiebre, de curso generalmente autolimitado. La trombosis del seno cavernoso (TSC) es una complicación poco frecuente, que se asocia a compromiso del seno esfenoidal y etmoidal, manifestándose clínicamente con cefalea, fiebre, alteración de pares craneanos y síntomas oculares. Ante su sospecha el estudio imagenológico es fundamental. En estos exámenes se debe buscar un defecto de llene en el seno cavernoso comprometido. El tratamiento debe iniciarse de forma precoz y contempla: antibioticoterapia, drenaje quirúrgico del seno afectado y anticoagulación. Se presenta a un paciente pediátrico masculino con TSC derecha posterior a una rinosinusitis esfenoidal no tratada, que respondió favorablemente al tratamiento. Se describe la clínica y manejo de esta patología, que presenta alta morbimortalidad, y que puede disminuirse considerablemente con un tratamiento precoz y agresivo.

ABSTRACT Acute bacterial rhinosinusitis is the infection of the nasal and paranasal mucous membrane, with symptoms such as nasal congestion, purulent rhinorrhea and fever, usually self-limiting. Cavernous sinus thrombosis (CST) is a rare complication, which is associated with sphenoid and ethmoid sinus involvement, clinically manifest with headache, fever, cranial nerve involvement and ocular symptoms. When suspected, imaging studies will confirm the clinical impression. They will show abnormal flow parameters in the compromised cavernous sinus. The treatment has to start as soon as possible and consists in broad spectrum intravenous antibiotics, surgical drainage of the site of the infection and anticoagulation. We present a patient with a right CST secondary to a non-treated sphenoidal sinusitis, that responded favorably to treatment. The clinical and management of this pathology is described, which presents a high morbidity and mortality that can be reduced considerably with an early and aggressive treatment.

Síndrome de seno cavernoso / Cavernous sinus syndrome

Resumen La trombosis del seno cavernoso es una enfermedad poco común, pero puede ser fatal. Se vincula con infecciones faciales, sinusitis o asépticas. El reconocimiento oportuno en pacientes con fiebre, cefalea y alteraciones en la exploración de movimientos oculares es importante para un buen pronóstico. Se comunica el caso de un paciente con síndrome de seno cavernoso, con meningitis por contigüidad.

Abstract Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection. Early recognition of cavernous sinus thrombosis in patients with fever, headache, eye findings such as periorbital swelling and ophthalmoplegia is critical for good outcome. We present the case of a patient with cavernous sinus syndrome with contiguous meningitis.

Compromiso de seno cavernoso como presentación de cáncer anaplásico de tiroides / Cavernous sinus involvement as presentation of anaplastic thyroid cancer

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.

Trombosis del enno cavernoso / Trombosis of the bosom carvernoso

La presencia de trombosis de seno cavernoso en edad pediátrica es poco frecuente en nuestro medio, la mayoría de estos cuadros ocurren habitualmente en adultos jóvenes, en la literatura actual existen pocos casos reportados de esta patología en edad pediátrica. Se presenta el caso clínico de un paciente femenino de 3 años y 11 meses de edad con antecedente de forúnculo en lóbulo de la nariz secundario a la picadura de insecto, sin mejoría del cuadro clínico con antibioticoterapia intravenosa, días después presenta alteración de la conciencia, oftalmoplejia, proptosis, disminución de la agudeza visual y edema palpebral bilateral; se realiza TC de cráneo y orbitas que demuestran imagen sugestiva de trombosis parcial del seno cavernoso izquierdo, sinusitis etmoidomaxilar bilateral. Del hemocultivo se aisló estafilococo aureus. Se manejo con antibioticoterepia agresiva de acuerdo al antibiograma con lo que mejora las condiciones del paciente, presentado paresia del recto externo del ojo izquierdo como secuela.

The presence of cavernous sinus thrombosis in childhood is not in our frequent since most of these tables usually occur in young adults in the current literature there are few reported cases of this disease in childhood. A case report of a female of 3 years and 11 months of age with antecedent to boil in the nose lobe secondary to insect bite without clinical improvement with intravenous antibiotics, days after an alteration of consciousness, Ophtalmoplegia, proptosis, loss of visual AGUDESA, bilateral chemosis and palpebral edema were performed cranial CT and MRI image demonstrating suggestive of partial thrombosis of the left cavernous sinus, sinusitis etmidomaxilar bilateral. Of blood crop Staphylococcus aureus was isolated. It antibiotic therapy with aggressive management, the patient was improving, with external rectus paresis of the left eye as a sequel after.