12 May 2026
: Case report 
Life-Threatening Orbital and Intracranial Sequelae of Odontogenic Sinusitis: 3 Complex Cases
Unknown etiology, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare coexistence of disease or pathology
Łukasz Skrzypiec
ABDEG 1*, Dariusz Jurkiewicz ACD 1, Marta Aleksandra Kwiatkowska ACDEF 1
DOI: 10.12659/AJCR.952050
Am J Case Rep 2026; 27:e952050
Table 1 Clinical presentation, imaging, and microbiological findings, with treatment and outcomes, in complicated odontogenic sinusitis cases.
| Case number | |||
|---|---|---|---|
| 1 | 2 | 3 | |
| Emergency Department | General Practitioner | Ophthalmology Department | |
| Headache and facial pain | Unilateral purulent nasal discharge and frontal headache | Periorbital swelling and ocular pain | |
| 10 days | 14 days | 3 days | |
| Altered mental status, meningitis symptoms | Neurological deterioration, severe frontal headache and agitation | Purulent nasal secretions, facial pain | |
| None | Extraction of the second maxillary molar | None | |
| Periapical abscess | N/A | Periodontitis, periapical lesions with OAC | |
| Unilateral sinusitis with complete opacification of left maxillary sinus, ethmoids, and frontal sinus, and periapical abscess of teeth 26 and 27 | Erosion of the left ethmoid roof with complete opacification of left and right maxillary sinus, ethmoids and frontal sinus | Near-complete opacification of the left paranasal sinuses with erosion of the lamina papyracea, subperiosteal orbital phlegmon, premaxillary abscess, and periapical lesions of teeth 25, 26, and 28 with OAC | |
| Diffuse sinus opacification with early frontal and temporal lobe parenchymal involvement | Left frontal lobe abscess with intraventricular rupture, extensive cerebral edema, and left sigmoid sinus thrombosis | N/A | |
| Left antro-ethmo-spheno-frontal sinusotomy, right antrostomy, septoplasty with extraction of teeth 26, 27 | Bilateral antrostomy, ethmoidectomy and left-side frontal sinusotomy | Extraction of teeth 25, 26, and 28 | |
| Meropenem | Ceftriaxone and metronidazole | Amoxicillin-clavulanate + clindamycin | |
| Completely recovered after targeted antibiotic therapy of 7 weeks with no neurological defects | Neurologically intact after 2 months of inpatient treatment with intravenous antibiotics | Resolution of orbital swelling without visual impairment. Mild nasal obstruction and mucopurulent discharge persisted | |
| OAC – oroantral communication, CT – computed tomography; MRI – magnetic resonance imaging; N/A – not available. | |||