Issue N# 5 - 2008
Major orbital complications of acute maxillary sinusitis of dental aetiology
Authors : Guibert M, Avenard M, Rose X, Cabos A, Pessey JJ, Serrano E. (Toulouse)
Ref. : Rev Laryngol Otol Rhinol. 2008;129,5:319-323.
Article published in french
Downloadable PDF document french
Objectives: To demonstrate the importance of searching for a dental aetiology when confronted with an orbital cellulitis secondary to an acute unilateral maxillary sinusitis and to diagnose and treat as soon as possible in order to avoid visual sequelae. Case report: two cases are presented. The first case of a 35 year-old man who was diagnosed and treated late, for an orbital abscess secondary to a sinusitis of dental origin. The patient presented with visual signs such as diplopia and impaired occulomotricity. The clinical diagnosis was concluded by an emergency sinus CT scan. Treatment consisted of an urgent surgical drainage associated to broad spectrum antibiotics with a high spectrum against Gram +cocci and anaerobes. Dispite this treatment regimen and two subsequent surgeries, the evolution was pejorative ending in a unilateral blindness. The second case is of a 45 year-old immunodeficient woman, presenting with the same pathology but without visual signs and whose evolution was satisfactory after adapted surgical and medical treatments. Discussion: The presence of visual and ocular signs warn on the gravity of the infection and indicate the need for urgent surgery. Sinus CT scan is essential to highlight the association between the orbit and the causal dental infection. For that, it must include the alveolar processes of the maxilla to show the dental lesion which is usually missed clinically. Functional endoscopic sinus surgery achieves two goals here; one diagnostic by the direct exploration of the nasal sinus cavities and the other therapeutic by the possible drainage all the paranasal sinuses.
Price : 8.50 €