Brain Abscess Potentially Resulting from Odontogenic Focus: Report of Three Cases and a Literature Review

Abstract

Introduction: Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection.

Case reports: The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and F. nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases.

Conclusions: Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.

Keywords: Brain abscess; Drainage; Magnetic resonance image; Odontogenic foci.

Fig. 1

Case I a axial diffusion-weighted magnetic resonance image (DWI) showing high signal intensity in suspected abscess formation and b axial gadolinium-enhanced T1-weighted magnetic resonance image (Gd-T1WI) showing ring enhancing lesion

Fig. 2

Case II a axial DWI showing suspected abscess formation, b axial Gd-T1WI image and c panoramic radiograph showing generalized advanced periodontitis of all residual teeth

Fig. 3

Case III a axial DWI showing suspected abscess formation, b axial Gd-T1WI, c panoramic radiograph showing localized advanced periodontitis of the right maxillary second molar, d axial DWI showing deteriorated abscess and e axial Gd-T1WI image showing deteriorated abscess