Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection

Abstract

Background Brain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess. Case presentation A 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient’s symptoms began to improve after the extractions. Conclusion This is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.

Microbiological Aspects Concerning the Etiology of Acute Odontogenic Inflammatory Diseases in the Soft Tissues of the Head and Neck Region

“…However, on the time being, the timing of these diseases indicates the prevalence of lympho-and hematogenous pathways of spread. Moreover, the local blood flow plays a key role in this [5], [14], [15]. In fact, abundant blood supply to the head and neck is characterized by a powerful network of anastomoses, potentially playing a role in the spread of infection [1].…”

Molecular diagnosis of polymicrobial brain abscesses with 16S-rDNA-based next-generation sequencing

“…Es konnte gezeigt werden, dass die Sanierung der Infektionsquelle einen Einfluss auf die daraus resultierende Hirnabszess-Infektion hat. Es kann dadurch eine gezielte Behandlung der Infektionsquelle ermöglicht und damit ein weiteres Anfeuern der Inflammation im Hirnabszess verhindert werden[59].Ein weiteres Problem bei der Verwendung vom Verfahren der nächsten Generation, die nur einen kleinen Abschnitt der variablen Region der 16S Untereinheit der ribosomalen Einheit sequenzieren, ist die richtige Spezieszuordnung von bestimmten Bakterien, die sich in diesem Bereich nur gering voneinander unterscheiden, sodass nur eine Identifikation auf Genus-Ebene gelingt[60]. Hier wurden jedoch auch bereits Ansätze entwickelt, wie die gesamte 16S DNS sequenziert werden kann, um so eine bessere Zuordnung auf Speziesebene zu ermöglichen[61].Ein Schwerpunkt dieser Arbeit soll auch auf die Verlässlichkeit der Ergebnisse beim Erregernachweis gelegt werden.…”

Potential infection foci in the oral cavity and their impact on the formation of central nervous system abscesses: A literature review

“…[24,25] Jung et al showed that odontogenic infections are a blood-borne cause of brain abscesses, accounting for < 2% of cases. [14,26] Recent dental treatments, such as tooth extraction and caries treatment, as well as poor oral hygiene and diseases, such as diabetes, are known risk factors for developing brain abscesses due to transient bacteremia associated with a decrease in immunity. [14] Clancy et al reported a rare parietal lobe abscess caused by Actinomyces meyeri 7 days after tooth 37 (mandibular left second molar) extraction in a generally healthy 55-year-old female.…”