Title: Odontogenic orbital cellulitis: Diagnosis and management
Abstract:
Introduction: Orbital cellulitis of odontogenic origin is a serious complication of dental infections, which can spread from a periapical inflammatory lesion to the periorbital tissues. Infections extending to the post-septal orbital space can lead to optic neuropathy, endophthalmitis and can be life-threatening when it spreads to the intracranial space, meninges and the brain. There is limited consensus on the management of such cases despite the potentially devastating consequences. Our study aims to present our experience and review the literature to provide a recommendation on recognising, investigating, and treating odontogenic orbital cellulitis.
Materials and Methods: OVID-Medline database was used to identify published original papers that addressed post-septal orbital cellulitis of an odontogenic source. 37 papers were identified for inclusion in our study. Demographics, signs, symptoms, investigation results, management, and outcomes were recorded for analysis. We also did a retrospective analysis to discuss a case study.
Results: Recent toothache caused by infection of maxillary premolar and molar teeth, or dental procedures including extraction or pulp extirpation of upper posterior teeth often preceded clinical presentation of orbital cellulitis. Notably, cases of severe vision loss were associated with oroantral communications which may have facilitated the uncontrollable spread of infection.
The most common symptoms upon presentation was ophthalmoplegia (75%). 30% of cases resulted in permanent vision impairment, ranging from minor restriction of extraocular muscle movement to complete vision loss. Streptococcus species (63.6%) were the predominantly cultured microorganism, followed by Staphylococcus (15%). Investigation using computed tomography can identify hallmark features such as asymmetrical sinus opacification and proptosis of the globe.
82% of cases ended up requiring surgical intervention alongside antibiotic therapy.
Conclusion: Early diagnosis of odontogenic post septal orbital cellulitis based on clinical presentation and radiological findings is critical to avoid serious complications. It is evident that antibiotic therapy is essential in the early management and is typically supported by surgical intervention for drainage and decompression. The potentially life-threatening nature of this condition underscores the importance of aggressive early management.
Audience Take Away:
• The audience will learn about the consequences of odontogenic orbital cellulitis, how to recognize it, how it commonly presents, how to investigate, prescribing antimicrobial cover, and surgical management.
• It is important for dental practitioners to understand the hallmark signs and potential risk factors from compromised maxillary dentition.
• Other faculties may use this to help develop local management guidelines.
