Clinical and radiological characteristics of odontogenic orbital cellulitis

• Published in: Journal of ophthalmic inflammation and infection 2024-10, Vol.14 (1), p.48-9, Article 48
• Main Authors: Tumuluri, Vinay, Tong, Jessica Y., Tumuluri, Krishna, Selva, Dinesh
• Format: Article
• Language: English
• Subjects: Cellulitis; Compartment syndrome; Dental complications; Dental infections; Medicine; Medicine & Public Health; Odontogenic orbital abscess; Odontogenic orbital cellulitis; Ophthalmology; Orbital abscess; Orbital cellulitis; Visual acuity
• ISSN: 1869-5760; 1869-5760
• DOI: 10.1186/s12348-024-00422-0

Purpose To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis. Method Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes. Results Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25–56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers ( n  = 1, 25%), hand movements ( n  = 1, 25%) and no perception of light ( n  = 2, 50%). The organisms implicated were Streptococcus milleri ( n  = 3, 75%) and Streptococcus constellatus ( n  = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration. Conclusions Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.