Department of Pediatrics, Tokai University Hachioji Hospital, 1838 Ishikawa machi, Hachioji, Tokyo, 192-0032, Japan.
Tokai J Exp Clin Med. 2024 Sep 20;49(3):117-121.
We encountered a case involving a brain abscess in the right frontal lobe of a 12-year-old girl who was diagnosed with a chief complaint of headache and nausea. Left maxillary sinusitis, a dental infection related to dental caries and apical periodontitis, was observed in the left maxillary first molar in addition to left frontal sinusitis also being present. In addition to administering antibacterial agents, extraction of the left maxillary first molar and drainage of the paranasal sinuses and brain abscess were performed. Follow-up over the course of 1 year and 5 months indicated that the patient had progressed without any sequelae; therefore, the prognosis was good. In this case, although bone destruction was observed in the posterior wall of the frontal sinus, which could be a route for bacteria to enter the skull, we considered the possibility of direct invasion from the same site to be low because the brain abscess occurred on the opposite side. We believe that a route for hematogenous invasion from apical periodontitis, in addition to sinusitis, is also possible. Regardless of the route, the outset was an infection in the dental field; therefore, this case reaffirmed the importance of dental cavity treatment in childhood.
我们遇到了一例 12 岁女孩右额叶脑脓肿的病例，该患者主要抱怨头痛和恶心。在左侧上颌第一磨牙中观察到左侧上颌窦炎，与龋齿和根尖周炎有关的牙齿感染，此外还存在左侧额窦炎。除了给予抗菌药物外，还进行了左侧上颌第一磨牙的拔出以及鼻窦和脑脓肿的引流。经过 1 年零 5 个月的随访，患者病情无进展，无后遗症，预后良好。在这种情况下，尽管观察到额窦后壁有骨质破坏，这可能是细菌进入颅骨的途径，但我们认为从同一部位直接侵犯的可能性较低，因为脑脓肿发生在对侧。我们认为，除了鼻窦炎之外，来自根尖周炎的血源性侵袭的途径也是可能的。无论途径如何，起始都是牙源性感染；因此，本例再次证实了儿童时期进行牙洞治疗的重要性。
