Correlation between dental infections and the development of cavernous sinus syndrome

Elawami, Hadil (2020-03-11)

"Cavernous sinus Thrombosis " It is a rare medical emergency and a life threatening condition in which blood clots are formed within the Cavernous sinus, through sepsis and disseminated Intravascular coagulation(1) . Because the Cavernous sinus contains vital neuronal structures, and the elevated risk of hemorrhage . Before the development of Antibiotics the mortality rate was almost 100%.(1) CST can be aseptic which may result from surgery or trauma . The spread of infection from infected teeth can proceed mainly by "Venous Pathways". CST has different symptoms depending on the affected anatomical structures(4): Lesions involving the entire sinus : Opthalmoplegia " the paralysis of the external extraocular muscles secondary to the dysfunction of CN III / CN IV ", Diplopia , Periorbital ecchymosis . Fixed dilated pupils " due to damage of the parasympathetic fibers ", Or even the Loss of vision (4). Impaired vascular drainage for the face and eyes : Meningitis, Subdural empyema "collection of pus between the dura and arachnoid matter"(2). Damage to the sympathetic plexus : Leads to Horner's syndrome "Miosis/ptosis/anhidrosis"(4) Damage to CN V (V1/V2): Sensory loss in face/scalp/maxilla/nasal cavity/palate (4) . Damage to CN VI Lateral gaze palsey "The inability to move the eye in a single direction" , which is an isolated early sign of CST (3).


Cavernous sinus and it's direct communication to dental structures can predispose individuals to "Cavernous sinus Thrombosis" , which can be developed due to the spread of : Paranasal Sinus infections in the (of dental origin) , Or due to the spread of infections from (Gingivitis)/(Parapharyngeal abscess) "in the Pharyngomaxillary space". Or an abscess in the buccal spaces via "Buccal mucosal laceration", which may be caused by an ill-fitted denture and dental extractions . Misdiagnosis and inappropriate treatment of Dental infections for example , The neglectance of Dental Hygiene , leads to the Development of CST.

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