title: Subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating removal of third molars.
abstract: We report a case of subdural empyema and herpes zoster syndrome (Hunt syndrome) complicating routine removal of third molars. Subdural empyema is an extremely rare but life-threatening complication of dental sepsis arising spontaneously or after dental surgery. The clinician should be familiar with its presentation and have a high index of suspicion, because late recognition and delay in its treatment can increase the associated morbidity and mortality. Surgical procedures and in particular maxillofacial surgery have also been known to trigger varicella zoster reactivation resulting in Hunt syndrome. Some patients develop the characteristic rash several days after the onset of facial weakness, so that Hunt syndrome may initially be misdiagnosed as Bell's palsy. We highlight the difficulties in diagnosing Hunt syndrome and argue the case for early treatment of all patients with Hunt syndrome and Bell's palsy with a combination of systemic steroids and antiviral drugs.
authors.affiliation: Maxillofacial Unit, Poole General Hospital, Longfleet Road, Poole, Dorset BH15 2JB, UK. parkash.r@ukgateway.net
authors.forename: P L
authors.initials: PL
authors.lastname: Ramchandani
authors.forename: T
authors.initials: T
authors.lastname: Sabesan
authors.forename: W J N
authors.initials: WJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D020330:Bell Palsy / Q000821:virology; D003937:Diagnosis, Differential; D013354:Empyema, Subdural / Q000821:virology*; D020804:Encephalitis, Varicella Zoster / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000502:physiology; D006801:Humans; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D011183:Postoperative Complications; D013577:Syndrome; D014081:Tooth Extraction / Q000009:adverse effects; D014775:Virus Activation / Q000502:physiology