Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report

Abstract

IntroductionTo date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity.Case presentationAn 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms.ConclusionsThe occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment.

Pattern of Odontogenic Fascial Space Infections among a Sample of Sudanese Patients

“…[6] This study showed that the most common antibiotic used was Metronidazole (48.32%). These findings were similar to the findings of Martine [17] and different from the findings of fasting who reported that clindamycin, gentamycin and linezolid were the predominant treatment used [3] Amoxicillin was reported by Rao dd et al and Singh M [8,18] respectively as the most used antibiotics.…”

Evaluating Complications of Chronic Sinusitis

“…Treatment of intracranial suppurative complication requires a combination of medical and surgical management. Medical management includes empiric antibiotic coverage with a third-generation cephalosporin and metronidazole [3, 9]. While aggressive broad-spectrum antibiotic treatment is universally accepted, it is important to realize that it is not an alternative to surgical management, and proper drainage of an epidural abscess should be carried out without delay [10, 11].…”

Misdiagnosed maxillary sinusitis: the case for further investigation

“…Laboratory studies are nonspecific. The differential diagnosis should include the following entitles: acute bacterial sinusitis with orbital involvement, orbital cellulitis, aspergillosis, candidiasis, cavernous sinus thrombosis, tuberculosis, midline facial granuloma, antral neoplasia, cellulitis and odontogenic abscesses (9,21). Definitive diagnosis requires histologic examination of involved tissue and visualization of broad, nonseptate hyphae with right angle branching.…”