Bilateral Cavernous Sinus Thrombosis Secondary to Dental Infection-Induced Sinusitis: A Case Report

Cavernous sinus thrombosis (CST) is a rare but severe condition that often arises as a complication of head and facial infections. Sinusitis, particularly involving the sphenoid or ethmoid sinuses, is a common precursor. A five-year-old boy presented to the pediatric intensive care unit with fever, ear pain, and eyelid swelling. Magnetic resonance imaging revealed rare bilateral CST with significant intracranial arterial narrowing. Cultures from the ear grew Fusobacterium necrophorum. Subsequent dental examination identified multiple untreated carious lesions, pulpal necrosis, and abscesses. Comprehensive dental rehabilitation, including extractions, pulpotomies, and stainless-steel crowns, was performed under general anesthesia in conjunction with otolaryngologic management. Following treatment, the CST resolved. This case illustrates a potential pathophysiological cascade where untreated dental caries contributed to sinusitis and otomastoiditis, ultimately leading to CST. The absence of valves in the facial and dural venous systems facilitates retrograde spread of infection, underscoring the importance of oral health in preventing severe systemic complications. While a direct microbial link was not confirmed, we postulate that the infection correlated with poor dentition, leading to sinusitis and subsequent CST. Bilateral CST is an uncommon but life-threatening condition that may originate from odontogenic sources. Prompt multidisciplinary evaluation, including dental assessment, is critical in achieving favorable outcomes in pediatric patients.