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Clinical and radiological characteristics of odontogenic orbital cellulitis
Vinay Tumuluri1, Jessica Y Tong2,3, Krishna Tumuluri4
1Faculty of Health and Medical Sciences, School of Dentistry, University of Adelaide, Adelaide, Australia. vinaytumuluri101@gmail.com.
Purpose:
To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis.
Method:
Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.
Results:
Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25-56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration.
Conclusions:
Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.
