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case_images: Axial slices on face and brain CT scan revealed extensive sinusitis involving the left maxillary sinus (A), anterior ethmoid (B), and frontal sinus (C). Additionally, it identified a well-defined, hypodense, crescent-shaped subdural collection in the right parietal area, measuring approximately 7 mm in size, consistent with SDE (D).
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case_images: The urgently performed face and brain Computed Tomography (CT) scan disclosed extensive sinus involvement on the left side (Figure 1A to C) and a well-defined, hypodense, crescent-shaped subdural collection in the right parietal area, measuring approximately 7 mm in size, consistent with SDE (Figure 1D).
case_images: Intra oral examination revealed multiple severely decayed teeth (26, 16, and 46).
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case_images: Dental examination identified multiple severely decayed teeth (26, 16, and 46) (Figure 2).
case_images: (A, B) Coronal slices on Face and brain CT scan revealed a deep decay on the antral tooth 26.
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case_images: Extraction of the decayed teeth (26 and 16) (A). Subsequently, an oro-antral communication created after extraction of the tooth 26 (B).
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case_images: Surgical removal of all the decayed teeth was performed (Figure 4A). During the extraction of tooth 26, an oro-antral communication occurred (Figure 4B), allowing pus aspiration for microbiological investigation.
case_images: The extraction sites were healed, and it appeared that the oral fistula had closed.
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case_images: The extraction sites healed with closure of oral fistula (Figure 5).
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case_images: Axial and sagittal slices on the brain CT revealed a millimetric, lentiform, right frontal extradural empyema measuring approximately 19 x 5 x 24 mm3. This empyema was causing compression of the ipsilateral ventricle and had resulted in an 18 mm midline shift, contributing to the compression under the falx cerebri and the onset of hydrocephalus (A-C). Additionally, coronal slices on the face and brain CT scan disclosed a right ethmoid-maxillary sinusitis of dental origin (D).
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case_images: The urgent brain CT scan revealed a millimetric right frontal extradural empyema measuring approximately 19 x 5 x 24 mm3, and causing ventricular compression and midline shift, indicative of hydrocephalus (Figure 6A to C). These findings were indicative of complications arising from right ethmoid-maxillary sinusitis of dental origin (Figure 6D). The CT scan revealed the presence of a right oro-antral communication associated with tooth 16 (Figure 6D).
case_images: Intra oral examination revealed multiple severely decayed teeth (16 and 18).
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case_images: This dental examination provided a potential source of the infection (Figure 7).
case_images: Extraction sites were healed without any oral fistula: (A) Day 5 post extraction and (B) Day 13 post extraction.
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case_images: Surgical removal of decayed and periapically involved teeth (16 and 18), presuming the epidural abscess to be of odontogenic infection led to significant pain reduction and successful healing of extraction sites (Figure 8).