Orbital cellulitis following dental extraction.

THE DEVELOPMENT OF ORBITAL CELLULITIS FOLLOWING EXTRACTION OF TEETH has been recognized clinically in a number of studies. 1-7 Because of the large number of dental extractions performed in the United States each year (estimated at 50 million in the American Dental Association Bureau of Economic and Behavioral Research 1979 Survey of Services Rendered), it is important to recognize the process by which this may occur. Organisms from an odontogenic source may gain entrance to the orbit through local tissue planes, by hematogenous spread, or by involvement of the paranasal sinuses. 7-9 With the present widespread use of antibiotics the clinician rarely observes the contiguous spread of dental infection to the orbit. When this process does occur the use of antibiotics may slow the spread of infection so that the underlying disease process may not be recognized. In some cases, however, such secondary factors as the virulence of the organism, the general health of the patient, or a poor choice in initial antimicrobial therapy may dispose certain patients to a rapid spread of infection. In four cases presented in this paper, all patients demonstrated elevated white blood cell counts and radiologic evidence of acute ipsilateral paranasal sinus infection. Fever was present in three patients. Meningitis developed in one. Possible predisposing factors were pregnancy with an upper respiratory tract infection in one patient, heroin addiction in another, and nephrotic syndrome with chronic antral infection in a third. The interval between dental extraction and development of orbital symptoms ranged from 2 hours to 13 days. The sequelae-subdural empyema