Odontogenic orbital inflammation: clinical and CT findings--initial observations

To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection.

Approval from the institutional review board was obtained for chart and scan review, and informed consent was waived for this HIPAA-compliant study. Five patients, two male and three female (median age, 37 years; age range, 13-55 years), who had odontogenic orbital cellulitis underwent clinical evaluation, CT scanning, and treatment. CT findings, including periapical lucency suggesting abscess, sinus opacification, and the route of spread of infection, were analyzed in each patient. Imaging, clinical, and surgical findings, including the initial clinical diagnosis and the presence of a periapical abscess at surgery and at pathologic examination, were compared.

Periapical lucency and sinus opacification were seen in all patients. The route of infection spread was through either the premalar soft tissues or the maxillary sinuses. The odontogenic origin of the orbital infection was not clinically suspected in any patients. Correct diagnosis was later made at CT in all patients. Four patients had periapical abscesses at pathologic analysis, and the fifth patient had apical periodontitis at clinical analysis and granuloma at pathologic analysis. Dental surgery was required in each of the five patients for resolution of infection; four patients underwent extraction of the infected tooth, and one patient underwent incision and drainage of a periapical abscess.

Abnormal periapical lucency, widening of the periodontal ligament space, and the presence of a subperiosteal abscess suggested an odontogenic origin of orbital infection.