A systematic review of orbital apex syndrome of odontogenic origin: Proposed algorithm for treatment

Abstract

Orbital apex syndrome (OAS) can be a rare, but severe complication of an odontogenic infection and has high morbidity and mortality. Antibacterial drugs are typically an appropriate treatment choice, but the most severe cases are fungal in nature and pose a tough challenge to the clinician. The aim of this study was to determine the predisposing factors, specific aspects in its management and the appropriate treatment strategy in order to improve patient outcome. A systematic review was conducted using PubMed, PubMed Central, Web of Science, and Scopus up to February 2020, based on the associations between dental extraction or infections and OAS. Of 721 papers found, 18 articles were considered eligible and presented in total 21 cases (13 fungal and eight bacterial infections). The information was organized into a diagnostic and treatment algorithm which included data extracted both from the included cases and updated literature of treatment efficacy studies. Immunosuppression (uncontrolled diabetes mellitus and chemotherapy) was found as an important predisposing factor particularly for fungal infections. In these cases, we suggest that early simultaneous approaches, including aggressive surgical procedures and systemic administration of amphotericin B, result in a better outcome. In conclusion, medical intervention success depends on aggressive treatment and multidisciplinary teamwork.

First reported case of Peptostreptococcus stomatis bacteremia in left orbit apex syndrome patient after dental repair

“…OAS can be caused by a variety of etiologies such as infection, tumor, and trauma [5]. Infections of odontogenic origin are uncommon, but very serious [6], the mortality rate can reach 54% [4]. Due to the rapid progress of the disease and the complex types of pathogens, it is di cult to cover the pathogen with empirical antibiotics treatment.…”

“…OAS has many etiologies, infection is less commonly reported, if happened, the progression is rapid, and the prognosis is extremely poor [3]. Among the few cases of infection, the pathogens are fungi and aerobic bacteria [4], while anaerobic bacteria are rarely reported, especially the newly discovered species of anaerobic bacteria, Peptostreptococcus stomatis. The aim of this study is to report a rare case of OAS caused by P.stomatis after restorative dentistry, to help clinicians to identify early atypical symptoms of the disease, enhance the medical history collection, and increase antimicrobial coverage in a precise manner.…”

Orbital apex syndrome secondary to apical periodontitis of a tooth: a case report

“…A systematic analysis of odontogenic OAS found that 18 of 21 patients had a history of tooth extraction and three had gingival infections, mainly including invasive fungal and bacterial infections, with a mortality rate of 54% [ 6 ]. OAS is a severe and uncommon complication of odontogenic infection with high rates of morbidity and mortality.…”