Diabetes Education Object and Effect Analysis, Result Relation - Xins Hospital of Stomatology, (471800) Wang Ting: Cavernous sinus intracranial thrombophlebitis is a serious complication of oral and maxillofacial infection, with very high mortality. In recent years, due to the improvement in medical treatment levels and the use of efficient antimicrobial drugs in clinical cases, there have been fewer reports. Our department had one case of deciduous teeth apical periodontitis therapy leading to cavernous sinus intracranial thrombophlebitis in 2001; the report follows:
1. Clinical Data:
The patient was male, 8 years old. He came to our department in March 2001. His parent reported toothache lasting 3 days, exacerbated overnight. Examination: deep caries on teeth - + J _, no gingival redness, no tooth loosening, percussion pain lIc (+), no pain from hot or cold stimuli. Initial impression: apicitis on teeth - + J _. Treatment included pulp Fc SpongeBob and systemic antibacterial drugs orally. The next day, facial swelling appeared, and penicillin and metronidazole were administered intravenously for 5 days continuously. The condition did not improve and produced a fever of 38.9°C, vomiting, and apparent hyperemia of the left eye.
Blood WBC: 20.0×10^9/L, then transferred to Luoyang hospital for treatment. Investigation: redness, tenderness, and swelling in the left maxillary sinus area, pharyngeal hyperemia, tonsils enlargement grade 1, left eye protrusion, restricted movement, decreased visual acuity. Laboratory examination: WBC 23.0×10^9/L, head CT shows: bilateral maxillary sinus and left ethmoid sinusitis. Dentistry, ENT, and neurology consultations led to an initial impression: cavernous sinus intracranial thrombophlebitis; paired maxillary sinusitis, left ethmoid sinusitis; apical periodontitis.
Result: Treatment included active anti-infection treatment and local anesthesia for the left maxillary sinus radical operation + ethmoidectomy (polyps found in both the left maxillary and ethmoid sinuses). After 25 days of hospitalization, the patient was cured.
Discussion: For these two patients, primary symptoms of toothache may be induced by infection factors in the oral and maxillofacial region. From the onset and course of treatment, predisposing factors for sinus also exist. Therefore, the cause of this disease can be roughly divided into two pathways: one caused by tooth infection, and another induced by sinus inflammation. Based on available data, oral and maxillofacial infections causing this disease mainly refer to the dangerous triangle furuncle, carbuncle, and maxillary inflammation before the anterior pathway and pathways. Afterward, odontogenic infection or iatrogenic infection such as anesthetic injection, extraction, etc., may occur.
We present a case of possible odontogenic infection. Cases of facial swelling often occur before and after treatment in our clinical work. However, with correct diagnosis and proper treatment, recovery generally occurs without serious consequences. Facial swelling should be considered a natural condition, not excluding pulp lesions of the bowel or tissue stimulation from disinfectants. Due to the anatomical and physiological characteristics of deciduous teeth with apical periodontitis in children, periapical infections spread rapidly. Periapical infections can quickly reach subperiosteal, forming palpable subcutaneous or submucosal swellings, and inflammation lasts for a long time in subperiosteal, not easily limited but developing space infections rapidly.
These are described as loose tissues in children's faces, in the absence of crush lesions or poor drainage conditions, inflammatory susceptible to superficial tissue proliferation, and not easily entering through the permanent tooth bud and alveolar bone deep development. From the head CT examination results, bilateral maxillary sinus and ethmoid sinus inflammation existed on the left side. Radical nephrectomy and ethmoidectomy of the maxillary sinus revealed inflammatory polyps in the maxillary and ethmoid sinuses, indicating chronic inflammation has been present for a long time. Available data describes that acute sinusitis in children can cause orbital cellulitis and other orbital complications, especially acute ethmoiditis causes much, and ethmoid sinus infections may also spread along the vascular and lymphatic systems to the orbit. The wall between the ethmoid sinus and the orbit is very thin, and some have fissures. Ethmoid sinus infections may also directly enter the orbit, causing orbital complications, which lead to intracranial complications.
In view of this, sinusitis causing this disease is more likely. Sinusitis, pharynx, and tonsil elements have their own factors, as well as tooth factors. Data shows that odontogenic sinusitis accounts for about 10% ~ 20%, and it is more common in adults, less common in children. This may be because of the anatomical location of deciduous and permanent teeth. From the history records of tonsillitis, children with tonsillitis and adenopharyngitis can not only cause sinusitis but also make sinusitis difficult to cure or repeatedly attack. Therefore, sinusitis caused by tonsil factors is closely related to its own. Data on sinusitis and teeth causing inflammation-related diseases are case reports. In this case, the cleverest aspect is that the teeth and sinusitis are all on the same side, and facial swelling is also difficult to distinguish dental factors or sinus factors. Only from the development of the disease and the treatment process analysis of the primary and secondary etiology, it may also be the result of several factors acting together.