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PICTURES IN CLINICAL MEDICINE
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Orbital Abscess Associated with Sinusitis from Odontogenic Origin Ali Akhaddar 1, Fouad Elasri 2, Mostapha Elouennass 3, Mohammed Mahi 4, Najib Elomari 5, Brahim Elmostarchid 1, Abdelbar Oubaaz 2 and Mohammed Boucetta 1 Key words: adolescent, dental complications, odontogenic infection, orbital abscess, paranasal sinusitis, Peptostreptococcus species (Inter Med 49: 523-524, 2010) (DOI: 10.2169/internalmedicine.49.3198)
Pi c t ur e1 . Fr o nt a lv i e wo ft hepa t i e nts ho wi ngl e f te y e ba l l pr o pt o s i s ,e r y t he ma ,c he mo s i sa ndpe r i o r bi t a ls we l l i ng . Pi c t ur e3 . Or bi t a lMRIo nT1 we i g ht e di ma g ewi t hg a do l i ni um i nj e c t i o n( c o r o na lv i e w)r e v e a l i ngal a r g er i ng e nha nc i ng c y s t i cma s si nt hel e f to r bi t( s t a r )wi t hs e v e r ei nde nt a t i o no f t hee y e ba l la ndt e mpo r a le x t e ns i o n.No t et hepa r a na s a ls i nus i nf l a mma t i o n.
A previously healthy 11-year-old girl was admitted with a painful swelling of the left periorbital region 2 weeks following a treatment of dental caries (first left upper molar cavity treatment). Five days before her admission, maxillary sinusitis was diagnosed and amoxicillin was prescribed. Despite the antibiotic, the situation worsened. On admission, Pi c t ur e2 . Co nt r a s t e nha nc e dc r a ni o o r bi t a lCTs c a n:Ax - she was afebrile with left exophthalmos, periorbital chymoi a lv i e w( A)a nds a g i t t a lr e c o ns t r uc t i o n( B)r e v e a l i ngal a r g e sis and restriction of eye movements (Picture 1). Visual acuo r bi t a la bs c e s so nt hel e f ts i de( s t a r )wi t hi nt r a o r bi t a lc e l l ul i - ity of the left eye was 4/20. Cranio-orbital neuroimaging ret i sa nds phe no e t hmo i da ls i nus i t i s . vealed a large left orbital abscess with intraorbital cellulitis
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Department of Neurosurgery, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco, ２Department of Ophthalmology, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco, ３Department of Bacteriology, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco, ４Department of Radiology, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco and ５Department of Hyperbaric Medicine, Mohammed V Military Teaching Hospital, University of King Mohammed V-Souissi, Rabat, Morocco Received for publication November 29, 2009; Accepted for publication December 2, 2009 Correspondence to Dr. Ali Akhaddar,
[email protected]
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Inter Med 49: 523-524, 2010
DOI: 10.2169/internalmedicine.49.3198
and paranasal sinusitis (Pictures 2, 3). Laboratory studies were normal except for the elevated C-reactive protein level (37.7 mg/L). Orbital abscess was surgically drained (18 mL) and culture grew Peptostreptococcus species. A 2-month regimen of antibiotherapy was given (amoxicillin/clavulanic acid, metronidazole and gentamicin for one week) with cor-
ticotherapy and hyperbaric oxygen exposure. The improvement was remarkable. This case should serve to emphasize the crucial requirement for intensive attention to ophthalmic, neurologic and paranasal symptoms following dental procedures (1, 2).
References 1. Sakkas N, Schoen R, Schmelzeisen R. Orbital abscess after extraction of a maxillary wisdom tooth. Br J Oral Maxillofac Surg 45: 245-246, 2007. 2. Vairaktaris E, Moschos MM, Vassiliou S, et al. Orbital cellulitis,
orbital subperiosteal and intraorbital abscess: report of three cases and review of the literature. J Craniomaxillofac Surg 37: 132-136, 2009.
Ⓒ 2010 The Japanese Society of Internal Medicine http://www.naika.or.jp/imindex.html
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