Caruso Paul A, Watkins Lynnette M, Suwansaard Pantip, Yamamoto Mika, Durand Marlene L, Romo Laura Vitale, Rincon Sandra P, Curtin Hugh D
Departments of Radiology and Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114, USA.
Radiology. 2006 Apr;239(1):187-94. doi: 10.1148/radiol.2391041243.
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.
回顾性分析牙源性眶内感染患者的计算机断层扫描（CT）及临床资料。
本符合健康保险流通与责任法案（HIPAA）的研究已获得机构审查委员会批准，可进行病历及扫描影像回顾，并免除了知情同意书。五例牙源性眶蜂窝织炎患者（两例男性，三例女性；中位年龄37岁；年龄范围13 - 55岁）接受了临床评估、CT扫描及治疗。分析了每位患者的CT表现，包括提示脓肿的根尖周透亮区、鼻窦混浊及感染扩散途径。比较了影像学、临床及手术所见，包括初始临床诊断以及手术及病理检查时根尖周脓肿的情况。
所有患者均可见根尖周透亮区及鼻窦混浊。感染扩散途径为经颧前软组织或上颌窦。所有患者临床均未怀疑眶内感染的牙源性起源。所有患者后来经CT均做出了正确诊断。病理分析时四例患者有根尖周脓肿，第五例患者临床分析为根尖周炎，病理分析为肉芽肿。五例患者均需进行牙科手术以控制感染；四例患者拔除了感染牙齿，一例患者进行了根尖周脓肿切开引流。
根尖周透亮区异常、牙周膜间隙增宽及骨膜下脓肿提示眶内感染的牙源性起源。
