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

Abstract

Background Orbital apex syndrome (OAS) is a rare disease with a noticeable mortality rate. Although its etiology has been repeatedly assessed, few reports have concentrated on odontogenic infection. We presented a rare case of OAS secondary to apical periodontitis. Case presentation A 61-year-old male was admitted to our hospital for a 3-day history of left orbital and head pain, along with diplopia for 1-day. He also had toothache symptoms before his admission. Due to the atypical early symptoms of orbital apex and cranial nerve injury, no timely and effective diagnosis and treatment were initially provided. However, as the disease progressed and complications occurred, we timely adjusted the diagnosis and successfully controlled the infection. During the one-year follow-up, no recurrence of inflammation was observed; nevertheless, the ptosis and ophthalmoplegia persisted. Conclusions OAS is a rare, while severe complication of odontogenic infection. This case had various symptoms and nerve injury in the orbital apical area. When disease is atypical in its early stages, treatment is easily overlooked. Early detection and suspicion of orbital apex-related complications should be heightened.

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

“…Xiang,W reported a case of OAS caused by Pseudomonas aeruginosa in a patient with periodontitis. Empirical ceftriaxone sodium combined with metronazole did not cover the pathogen, resulting in progressive decline of vision and aggravation of the patient's condition [3], nally, P.aeruginosa was found by using metagenomic nextgeneration sequencing (mNGS) in cerebrospinal uid, and the treatment scheme was changed to control the disease. In addition, there are reports of fungal infection [18], so etiological evidence is an important basis for treatment.…”

“…Orbital apex syndrome (OAS) is a syndrome due to lesions in the orbital apex region, which is associated with dysfunction of cranial nerves II, III, IV, VI and the ophthalmic branch of the trigeminal nerve (V1) with optic nerve dysfunction [1,2]. 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.…”