Akashi Masaya, Tanaka Kazuhiro, Kusumoto Junya, Furudoi Shungo, Hosoda Kohkichi, Komori Takahide
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan.
J Maxillofac Oral Surg. 2017 Mar;16(1):58-64. doi: 10.1007/s12663-016-0915-5. Epub 2016 May 13.
Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection.
The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified in case 1, , , and in case 2, and , , and in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases.
Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.
牙源性病灶极少引起颅内感染。血行播散被认为是牙源性颅内感染最重要的病理生理机制。为了探究颅内感染的口腔来源，口腔外科医生应了解口腔细菌扩散至中枢神经系统的潜在机制。然而，牙源性感染导致颅内感染的报道非常少见。
作者报告了3例病例，分别为1名64岁男性、1名68岁男性和1名64岁女性，他们的脑脓肿可能源于牙源性病灶，因为未发现其他颅内感染源，如心内膜炎和上颌窦炎。对脑脓肿标本进行细菌学检查，病例1鉴定出……，病例2鉴定出……，病例3鉴定出……。在所有3例病例中，所有可疑的致病牙齿均无明显急性炎症迹象。
口腔外科医生应了解牙源性脑脓肿的这些特征，即潜在的致病牙源性病灶通常缺乏急性症状。如果未发现其他感染源，为改善口腔卫生，最好消除潜在的致病牙源性病灶，然而，消除可疑致病牙齿的决策标准仍有待阐明。
