Subacute Cavernous Sinus Thrombosis following a Dental Procedure: Case Report and Review of the Literature

Abstract

Objectives: Cavernous Sinus Thrombosis is a rare but serious condition. Despite increasingly effective treatment, the mortality and risk of long-term sequelae remains significant. The objective of this study is to describe the case of a 62 year old female presenting to a cardiovascular clinic with symptoms indicating an atypical subacute cavernous sinus thrombosis secondary to a dental procedure, and review the literature regarding cavernous sinus thrombosis following dental procedures and dental infections.

Methods: The study design is a Case Report and Systematic Review. A PubMed literature search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and limited to studies published between 2015 and 2020 (April).

Results: The case describes a 62 year old female with a 5 month history of left upper eyelid swelling, diplopia, chemosis, ptosis, and left sided cluster headache who was diagnosed with subacute cavernous sinus thrombosis treated with oral anticoagulation. The search strategy yielded a total of 15 titles, and of these, 9 were included in the qualitative synthesis. These demonstrated that cases of CST occur acutely, and clinical symptoms are variable, depending on the structures involved. Most cases are treated with IV antibiotics, and corticosteroids may be added. Anticoagulation therapy shows contradicting information regarding reduced mortality, but reduced morbidity is seen when used early and combined with antibiotics.

Conclusion: Not all cases of CST present typically and acutely, so it is advisable to have a high clinical suspicion and obtain an MRV to rule out CST when stumbling upon ocular symptoms or infections in the danger triangle of the face following a dental procedure or infection. Despite the conflicting views on the benefits of anticoagulation in the setting of CST, the addition of oral anticoagulation yielded a positive outcome in our patient.

Keywords: Subacute cavernous sinus thrombosis; cavernous sinus thrombosis; dental infection; dental procedure.