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Odontogenic sinusitis causing orbital cellulitis.

P Mehra1, A Caiazzo, S Bestgen

  • 1Boston University-Tufts University Oral and Maxillofacial Surgery Programs, USA.

Journal of the American Dental Association (1939)
|July 28, 1999
PubMed
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Odontogenic sinusitis can rarely be caused by resistant bacteria like MRSA, particularly in immunocompromised individuals or IV drug users. Orbital extension requires hospitalization and intravenous antibiotics.

Area of Science:

  • Otolaryngology
  • Infectious Diseases
  • Oral Surgery

Background:

  • Odontogenic sinusitis is typically treated with standard antibiotics targeting common oral and sinus bacteria.
  • Standard treatments are usually effective for most cases of sinusitis originating from dental issues.

Observation:

  • A patient presented with acute sinusitis following a complex tooth extraction, resistant to conventional therapy.
  • The sinusitis progressed to involve the orbit, indicating a severe complication.
  • Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the sinus, an unusual pathogen for this condition.

Findings:

  • The isolated MRSA strain was identified as the causative agent of the refractory sinusitis and orbital extension.
  • This case highlights a rare but serious presentation of odontogenic sinusitis.

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Implications:

  • Resistant bacterial infections, such as MRSA, should be considered in odontogenic sinusitis, especially in at-risk populations (IV drug users, immunocompromised patients).
  • Orbital extension of sinusitis necessitates inpatient management with intravenous antibiotic therapy.
  • This case underscores the importance of considering atypical pathogens in treatment-resistant sinusitis.