Orbital abscess after extraction of a maxillary wisdom tooth

doi:10.1016/j.bjoms.2005.09.010

British Journal of Oral and Maxillofacial Surgery

Volume 45, Issue 3, April 2007, Pages 245-246

https://doi.org/10.1016/j.bjoms.2005.09.010 Get rights and content

Abstract

A 21-year-old patient with orbital abscess and vision loss left after wisdom-tooth extraction is presented.

Introduction

The extension of dental abscesses to the orbital and periorbital spaces is a rare complication after dental extractions.1, 2, 3, 4, 5, 6, 7, 8, 9, 10

The microorganisms can enter the orbit in several ways. A dental infection can enter the maxillary sinus and through the inferior orbital fissure, the periorbital space.¹⁰ Microorganisms can enter the pterygopalatine fossa or infratemporal fossa and through the pterygoid venous plexus into the ophthalmic vein. Odontogenic infections can also spread into the orbit through anastomoses of the angular vein with the supratrochlear and supraorbital vein.1, 2

Section snippets

Case report

A 21-year-old man was admitted to our clinic with a painful swelling of the left cheek and the periorbital region 5 days after extraction of wisdom-teeth 18, 28, 38, and 48 by his dentist. We explored the extraction site 28 without finding pus. We gave him intravenous antibiotics(1× penicillin 10 mega and 2 × 500 mg metronidazole), but the following morning we found deterioration of vision and proptosis (Fig. 1) and chemosis. An ophthalmologist found obstruction of the left arteria centralis

Discussion

Orbital abscess or orbital cellulitis is almost always secondary to acute sinusitis. Other causes are laceration of the eyelid, dental operations, infection of the nasal septum, infected penetrating keratoplasty, varicella infection, and upper respiratory tract infection.¹⁰ In our case, the extraction of wisdom tooth 28 was the origin of the odontogenic infection, which extended into the orbital and periorbital spaces and led to an orbital abscess.

Odontogenic infection can enter the orbit

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B.P. Allan et al.
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Orbital infection arising from a primary tooth: a case report
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There are more references available in the full text version of this article.

Cited by (13)

Does the use of amoxicillin/amoxicillin–clavulanic acid in third molar surgery reduce the risk of postoperative infection? A systematic review with meta-analysis
2019, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
It was found that 10 patients needed to be treated with amoxicillin–clavulanic acid and 26 with amoxicillin alone to prevent one case of postoperative infection. When considered in light of the fact that most postoperative infections in a minor surgical procedure like third molar surgery usually resolve completely after rescue medication56–59 and the paucity of longitudinal clinical trials evaluating the impact of antibiotic treatment on the development of antibiotic-resistant bacteria, this information suggests that the prophylactic use of amoxicillin for this procedure based on current evidence should be investigated further. Arteagoitia et al.29 have previously investigated the effectiveness of amoxicillin and amoxicillin–clavulanic acid for the prevention of dry socket and infections after third molar surgery.
The objectives of this systematic review were to investigate the efficacy of amoxicillin/amoxicillin–clavulanic acid for reducing the risk of postoperative infection after third molar surgery and to evaluate the adverse outcomes in these patients, as well as in healthy volunteers. A systematic search of four databases was performed on May 26, 2017. Eleven studies qualified for the qualitative analysis and eight were found suitable for meta-analysis. The results suggest that both amoxicillin–clavulanic acid and amoxicillin significantly reduce the risk of infection after third molar extraction (overall relative risk (RR) 0.25, P < 0.001). However, with the exclusion of randomized controlled trials with a split-mouth design (due to an inadequate crossover period after antibiotic treatment), only amoxicillin–clavulanic acid was found to be effective (RR 0.21, P < 0.001). The risk of adverse effects was significantly higher in the amoxicillin–clavulanic acid group (RR = 4.12, P = 0.023) than in the amoxicillin group (RR 1.57, P = 0.405). In conclusion, amoxicillin–clavulanic acid and amoxicillin may significantly reduce the risk of infection after third molar extraction. However, their use in third molar surgery should be viewed with caution, as recent clinical trials on healthy volunteers have shown evidence of the negative impact of amoxicillin use on bacterial diversity and antibiotic resistance.
Orbital abscess during endodontic treatment: A case report
2012, Journal of Endodontics
Citation Excerpt :
The incidence of visual loss in cases of odontogenic orbital cellulitis reached up to 46% of severe vision loss (8). Other sequelae reported for orbital infections are meningitis, cavernous sinus thrombosis, brain abscess, hemiparesis, seizures, subdural empyema, superior orbital fissure syndrome, orbital apex syndrome, and death (1–6, 8–10). In this case, no permanent visual or systemic sequelae were observed.
Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature.
The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region.
The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation.
Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease.
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Short communicationOrbital abscess after extraction of a maxillary wisdom tooth

Abstract

Introduction

Section snippets

Case report

Discussion

J Oral Maxillofac Surg

J Am Dent Assoc

Int J Oral Maxillofac Surg

Am J Otolaryngol

Orbital infection arising from a primary tooth: a case report

Int J Paediatr Dent

Short communication
Orbital abscess after extraction of a maxillary wisdom tooth