Manor Yifat, Garfunkel Adi A
Eur J Oral Implantol. 2018;11(1):113-117.
To describe a rare case of odontogenic brain abscess.
A healthy, 35-year-old male had two dental implants placed in a simultaneously augmented maxillary sinus. One implant failed and the patient developed a maxillary sinusitis that failed to improve following antibiotic treatment at home. The neglected sinus infection led to formation of a brain abscess. The patient was hospitalised only when he had pan sinusitis with neurological signs. Symptoms were headache attacks, a subfebrile fever and a purulent secretion from the left nostril. The osteomeatal complex was blocked, the maxillary sinus was filled with pus and the Schneiderian membrane thickened. The patient was treated with intravenous antibiotic treatment. Computerised tomography (CT) and magnetic resonance imaging (MRI) scans and functional endoscopic sinus surgery (FESS), were implemented. When his conditions worsened, the patient underwent a left frontal mini craniotomy.
Following the craniotomy and antibiotic treatment, there was a gradual resolution and the patient was dismissed after 2 months in hospital with no neurological deficit or signs of sinusitis.
Maxillary sinusitis following dental implant insertion and concomitant maxillary sinus elevation should be treated immediately and thoroughly since untreated sinusitis may cause life-threatening situations such as a brain abscess. In case of severe infection, clinicians should refer immediately the patient to hospital specialists.
描述一例罕见的牙源性脑脓肿病例。
一名35岁健康男性在同时进行上颌窦增高术时植入了两颗牙种植体。其中一颗种植体失败，患者患上了上颌窦炎，在家接受抗生素治疗后病情未改善。被忽视的鼻窦感染导致脑脓肿形成。患者仅在出现全鼻窦炎并伴有神经症状时才住院。症状包括头痛发作、低热和左侧鼻孔脓性分泌物。鼻窦口复合体堵塞，上颌窦充满脓液，鼻窦黏膜增厚。患者接受了静脉抗生素治疗，并进行了计算机断层扫描（CT）、磁共振成像（MRI）扫描以及功能性鼻内镜鼻窦手术（FESS）。当病情恶化时，患者接受了左额部微创开颅手术。
开颅手术和抗生素治疗后，病情逐渐缓解，患者住院2个月后出院，无神经功能缺损或鼻窦炎迹象。
牙种植体植入及同期上颌窦增高术后发生的上颌窦炎应立即进行彻底治疗，因为未经治疗的鼻窦炎可能导致危及生命的情况，如脑脓肿。在发生严重感染时，临床医生应立即将患者转诊至医院专科医生处。
