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From:philippe sleiman
Sent: Saturday, March 14, 2009 3:26 AM
To: ROOTS
Subject: [roots] cavernous sinus
does any one have the experience of a cavernous sinus infection due to
a upper molar AR going all the way ? - Philippe
I thought in the antibiotics days that threat to mankind was eliminated.
- Dr Sanjay Jamdade
Although in medicine everything is possible, case must be quite severe
to link molar infection with cavernous sinus infection.
Will you tell us more about this case.
Treatment is extraction, drainage of sinus and full antibiotic coverage
as long as needed. ( and unfortunately it sometimes does not help -
hope your case will end up differently and patient will do well )
Use to see similar cases (caused by frontal teeth infections, though )
once or twice per year 20 years ago. Fortunately, severe OMF infections
are quite rare nowadays here.
Any OMF surgeons on the list from India may have extensive experience
with such infections ? - Valeri Stefanov
Dear Valerie, Extraction in my opinion should be the last option as it
would create a huge access for bacteria, i took the conservative road
and did a root canal treatment, with huge precaution in order to prevent
a flair up that could be fatal to the patient, and i did a second ICat
and everything is going back in order. will post soon the pictures.
- Philippe
Philippe, Are you sure then you are talking about cavernous sinus
infection caused by a molar tooth ?
To reach cavernous sinus such an infection has to get through maxillary
sinus first ? So, your whole maxillary sinus shold have to be occupied
by an infection before reaching cavernous sinus. Infection from upper
molar reaching cavernous sinus via "blood route" is almost impossible,
although as I mentioned all is possible in medicine. There have been
cases reported of a brain abcess due to periodontal infection in area
of lower incisors in compromised patients ! - Valeri / Mr. :-) /
Dear Valerie, i know the cavernous sinus, and i know that in history
2 cases were reported dead of such an infection.
this is a sagital plan showing the way that the abscess was taking it
is scarry. and the infection reaching the caverous sinus - Philippe
Philippe, Will you send the scans as attached files. - Valeri
Philippe, From what I see on reformatted CT maxillary sinus is heavily
involved and I doubt this case could be solved by doing RCT of the
molar only ? My very humble opinion of course :-).
About the death rate - it is higher for sure, because other cases are
reported in literature in other languages beside English, too.
- Valeri
Valerie, you should believe in power of Endodontics :)
this a post op I cat.... i will pblish this case this is why i am not
posting the whole x rays - Philippe
I also see CT was made in December 2008, so I guess patient was lucky
enough and probably is doing fine now :-) - Valeri
Philippe, are you speaking of a cavernous sinus thrombosis i.e. brain
involvement. This is generally related to anterior teeth but certainly
could come from a posterior. Tooth removal or even tooth tx would be
secondary to aggressive inpatient hospital care with neurological
medical intervention. I do not think dentists should be treating this
when it hits this point - Guy
Guy, you are absolutely right, when the patient walked in my office and
asked for additional info like scan and blood test, i called several
Drs , neurologist, neuro-surgeon, E&T... and we did put a plan. but the
treatment was root canal treatment with precaution for the upper 6. and
thx good that it worked well and u can see the post- op I- cat.
- philippe |
