Cavernous sinus thrombosis is one of the major complications of abscesses of the maxillofacial region The initial symptoms of CST are usually pain in the eye and tenderness to pressure. This is associated with high fluctuating fever, chills,
rapid
pulse, and sweating. Venous obstruction subsequently causes edema of the eyelids, lacrimation, proptosis, chemosis and retinal hemorrhages. Blindness is sometimes an accompaniment of cavernous sinus thrombosis when the infection also involves the
orbit.
There is also cranial nerve involvement (oculomotor, troclear, abducence) and ophthalmoplegia, diminished or absent corneal reflex, ptosis, and dilation of the pupil occur. The terminal stages bring signs of advanced toxemia and meningitis.
Infections
of the face can cause a septic thrombosis of the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of acute infection and especially curettage of the
sockets under such circumstances can cause this condition. The infection is usually staphylococcal. The infection may spread directly through the pterygoid plexus of veins and the pterygomaxillary space and then ascend into the sinus or it may
spread
directly from the pterygopalatine space to the orbit. This is possible because of the absence of valves in the angular, facial, and ophthalmic veins. The treatment is empirical antibiotic therapy followed by specific anbibiotic therapy based on
blood or
pus culture. The infection usually involves one side. However, it may easily spread to the opposite side through the circulus sinus. Unless it is treated early, the prognosis is poor even in this era of antibiotics. The antibiotic to which the
organism
is most susceptible is given in large doses. Occasionally the antibiotics will not adequately resolve the septic thrombus, and death ensues. The use of anticoagulants to prevent venous thrombosis has been recommended, but the efficacy of such
therapy
has not been substantiated. Surgical access through eye enucleation has been suggested.
We report a case which demonstrates cavernous sinus thrombosis by the infection after the functional neck dissection and the intraoral reconstruction with auriculomastoid fascio-cutaneous island flap.
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