A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.
Abscess ; Aged ; Cartilage ; Cavernous Sinus Thrombosis ; Dental Implants ; Early Diagnosis ; Female ; Headache ; Humans ; Immunocompromised Host ; Incisor ; Liver Cirrhosis ; Nasal Obstruction ; Nasal Septum ; Nose ; Sepsis ; Sphenoid Sinus ; Sphenoid Sinusitis

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.
Adult ; Anti-Bacterial Agents ; Anti-Infective Agents ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Dilatation ; Diplopia ; Drainage ; Early Diagnosis ; Ecchymosis ; Emergency Service, Hospital ; Female ; Health Education, Dental ; Heparin ; Humans ; Mortality ; Rare Diseases ; Tooth Extraction ; Veins

Prior to the advent of efficacious antimicrobial agents, the mortality rate from cavernous sinus thrombosis (CST) was effectively 100%. There have been very few reports of CST associated with tooth extraction. A 40-year-old female presented to the emergency room with swelling over the right side of the face and history of extraction in the upper right region by an unregistered dental practitioner. The patient presented with diplopia, periorbital ecchymosis, and chemosis of the right eye. A computed tomography scan revealed venous dilatation of the right superior ophthalmic vein. The patient was immediately treated with incision and drainage, intravenous antibiotics, and heparin (low molecular weight). Unfortunately, the patient died two days after surgery due to complications from the disease. CST is a rare disease with a high mortality rate. Therefore, dental health education in rural areas, legal action against unregistered dental practitioners, early diagnosis, and aggressive antibiotic treatment can prevent future mortality resulting from CST.
Adult ; Anti-Bacterial Agents ; Anti-Infective Agents ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Dilatation ; Diplopia ; Drainage ; Early Diagnosis ; Ecchymosis ; Emergency Service, Hospital ; Female ; Health Education, Dental ; Heparin ; Humans ; Mortality ; Rare Diseases ; Tooth Extraction ; Veins

BACKGROUND AND PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an immune-mediated chorioretinal disease that causes acute visual symptoms with characteristic ophthalmoscopic findings. Neurological complications are rarely reported in the literature. Here we report two new cases of APMPPE that presented with neurological manifestations, one of which was associated with peripheral neuropathy, which has not been described before. METHODS: A retrospective database review of all patients with a diagnosis of APMPPE was performed. Clinical, ophthalmological, and neurological data were analyzed, and only cases of APMPPE with neurological complications were included. A literature review of several databases was also performed, and previous case reports were reviewed and analyzed in detail. RESULTS: In total, 56 cases of APMPPE-associated neurological complications were included in the analyses: 54 from the literature and 2 from our own practice. The most common complication was cerebral vasculitis, which affected 28 patients (50%), followed by headaches in 15 patients (26.8%). The other complications include sixth-cranial-nerve palsy, transient hearing loss, meningoencephalitis, cavernous sinus thrombosis, and viral meningitis. CONCLUSIONS: This report adds to the literature of a novel association of APMPPE with peripheral neuropathy, and comprehensively reviews the neurological manifestations of this disease. A high level of suspicion should be applied when dealing with a case of APMPPE. We recommend applying detailed clinical neurological examinations and magnetic resonance imaging to APMPPE patients, and then early steroid treatment if the examination is positive or even suspicious. Early treatment with steroids and long-term treatment with immunosuppressive azathioprine with interval neurological evaluations will contribute positively to the outcomes and avoid fatal complications, namely strokes.
Adrenal Cortex Hormones ; Azathioprine ; Cavernous Sinus Thrombosis ; Diagnosis ; Headache ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Meningitis, Viral ; Meningoencephalitis ; Neurologic Examination ; Neurologic Manifestations* ; Paralysis ; Peripheral Nervous System Diseases ; Retrospective Studies ; Steroids ; Stroke ; Vasculitis, Central Nervous System

In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
Cavernous Sinus Thrombosis* ; Focal Infection, Dental ; Humans ; Mouth ; Surgery, Oral ; Trismus*

Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.
Abscess ; Cavernous Sinus ; Cavernous Sinus Thrombosis* ; Cranial Nerve Diseases ; Exophthalmos ; Fever ; Focal Infection, Dental ; Lacerations ; Nose ; Sepsis

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.
Adolescent ; Anti-Bacterial Agents ; Brain Abscess ; Cavernous Sinus Thrombosis ; Central Nervous System ; Child* ; Diagnosis ; Empyema, Subdural* ; Fever ; Frontal Sinus ; Frontal Sinusitis ; Headache ; Humans ; Inpatients ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Meningitis ; Orbit ; Paralysis ; Sinusitis*

Osteopetrosis is a rare genetic bone disease characterized by increased bone density but prone to breakage due to defective osteoclastic function. Among two primary types of autosomal dominant osteopetrosis (ADO), osteopetrosis type II is characterized by sclerosis of bones, predominantly involving the spine, the pelvis, and the skull base. Fragility of bones and dental abscess are leading complications. This report presents a case of osteopetrosis in a 52-years-old female, which was complicated by the development of cavernous sinus thrombophlebitis and meningitis. She was suffered from multiple fractures since one year ago. Laboratory data revealed elevated serum levels of tartrate resistant acid phosphatase (TRAP) without carbonic anhydrase II DNA mutation. A thoracolumbar spine X-ray showed, typical findings of ADO type II (ADO II; Albers-Schonberg disease), prominent vertebral endplates so called the 'rugger jersey spine'. Her older sister also showed same typical spine appearance. We report a case of ADO II with cavernous sinus thrombophlebitis and meningitis that was successfully treated with long-term antibiotics with right sphenoidotomy.
Abscess ; Acid Phosphatase ; Anti-Bacterial Agents ; Bone Density ; Bone Diseases ; Carbonic Anhydrase II ; Cavernous Sinus Thrombosis* ; DNA ; Female ; Humans ; Meningitis* ; Osteoclasts ; Osteopetrosis* ; Pelvis ; Sclerosis ; Siblings ; Skull Base ; Spine

OBJECTIVETo discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus.

METHODSThe clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time.

RESULTSAfter treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications.

CONCLUSIONSCavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.

Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Cavernous Sinus Thrombosis ; etiology ; therapy ; Child ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Mycoses ; complications ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; complications ; Young Adult

Rhino-orbito-cerebral mucormycosis (ROCM) is caused by invasion of orbital and intracranial structures directly or through the blood vessels of fungi of the Order Mucorales. It is the most fulminant form of mucormycosis and can manifest brain abscess, cranial nerve palsies, thrombosis or aneurysm, as well as sinusitis, facial or nasal deformity. We report one ROCM case complicated by recurrent cerebral infarctions after involvement of cavernous sinus and meningeal inflammation, despite treatment with surgical debridement and high dose intravenous amphotericin B.
Amphotericin B ; Aneurysm ; Blood Vessels ; Brain Abscess ; Cavernous Sinus ; Cerebral Infarction ; Congenital Abnormalities ; Cranial Nerve Diseases ; Debridement ; Fungi ; Inflammation ; Meningitis ; Mucorales ; Mucormycosis ; Orbit ; Sinusitis ; Thrombosis ; Vasculitis