Orbital abscess during endodontic treatment: a case report.
BACKGROUND
Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature.


METHODS
The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region.


RESULTS
The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation.


CONCLUSIONS
Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease.
Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Eduardo Henrique Pantosso
EH
de Medeiros
André Oliveira
AO
Pepato
Cássio Edvard
CE
Sverzut
Alexandre Elias
AE
Trivellato
D005260:Female; D006801:Humans; D015835:Ocular Motility Disorders / Q000209:etiology / Q000601:surgery; D054517:Orbital Cellulitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D009957:Oroantral Fistula / Q000150:complications / Q000209:etiology / Q000601:surgery; D010482:Periapical Abscess / Q000150:complications* / Q000601:surgery; D011859:Radiography; D012390:Root Canal Therapy / Q000009:adverse effects*; D014081:Tooth Extraction