{"paper_id":"44e8d3b7-18c2-4af3-8ae3-aa55d2f7488d","body_text":"Clinical and radiological characteristics of odontogenic orbital cellulitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical and radiological characteristics of odontogenic orbital cellulitis Vinay Tumuluri, Jessica Y. Tong, Krishna Tumuluri, Dinesh Selva This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4619929/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Oct, 2024 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted 7 You are reading this latest preprint version Abstract 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. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Odontogenic orbital cellulitis (OOC) represents 3–5% of orbital cellulitis cases [ 1 ] , and tends to have a poor clinical course with complications including vision loss, septicaemia and cavernous sinus thrombosis [ 1 – 3 ] . The route for odontogenic spread of infection to the orbit can occur via the maxillary premolars and molars or spread via the infratemporal fossa up into the inferior orbital fissure. Oral pathogens are more likely to be associated with anaerobic organisms and the lack of empirical antibiotic coverage combined with its inherent virulence may result in more adverse outcomes. Therefore, prompt recognition of OOC is crucial to direct appropriate antimicrobial treatment and timing of surgical drainage. The existing literature is predominated by case reports highlighting the broad and unique microbiological profile of odontogenic organisms and associated vision loss [ 4 – 25 ] . This study presents a case series of 4 patients with OOC while examining the microbiological profile, clinico-radiological features and ophthalmic outcomes. Methods The authors performed a retrospective study of patients admitted with OOC at major tertiary referral centres in Sydney and Adelaide, Australia. Study variables included data on demographics (age, sex, pre-existing medical conditions), ophthalmic findings (visual acuity, intraocular pressure, proptosis, dystopia, optic neuropathy), details of the odontogenic infection (dental procedure, intravenous/oral antibiotic use), investigations (fever, leukocytosis, inflammatory markers, blood cultures), radiographic findings (CT and MRI) and management. Institutional ethics approval was obtained and the study followed the tenets of Declaration of Helsinki. Results The clinical summary of each case is presented below and further summarised in Tables 1 and 2 . A literature review of all published reports of odontogenic orbital cellulitis is provided in Supplementary Table 1. Case Presentations Case 1 A 25-year-old Caucasian male was admitted with a 3 day history of right tooth and jaw pain with progressive periorbital oedema. On examination, visual acuity of the right eye was no perception of light (NPL) with raised intraocular pressure (IOP) of 50mmHg, 6mm of proptosis and a relative afferent pupillary defect (RAPD). Orthopantomogram (OPG) showed an abscess of the second lower right molar (47) with periapical lucency and widening of the periodontal ligament (PDL) space (Fig. 1 – 2 ). CT orbital scans demonstrated an extensive subperiosteal abscess of the right orbital floor, lateral wall, and roof with soft tissue enhancement of the infratemporal fossa and parapharyngeal space. A lateral canthotomy and cantholysis was performed. The patient underwent urgent drainage of the subperiosteal abscess in conjunction with extraction of the right molar tooth (47) and drainage of the dental abscess. Intraoperative orbital swabs showed growth of Streptococcus milleri sensitive to penicillin. The patient was treated with a combination of IV ceftriaxone, vancomycin, tazocin and meropenem. He was discharged 12 days post-admission with no improvement in vision. At 5 months follow-up, the right eye vision remained no light perception with evidence of optic atrophy. Case 2 A 38-year-old Chinese man presented with a 1 day history of right eye pain, periocular swelling and erythema. The patient had extraction of an upper right molar tooth (16) 1 day prior and presented with almost complete ophthalmoplegia. On presentation, his visual acuity was hand movements with an IOP of 45 mmHg. Orbital compartment syndrome necessitated an emergent lateral canthotomy. Under the guidance of Infectious Diseases, he was commenced on IV amoxicillin/clavulanic acid and metronidazole on admission and within 24 hours was changed to vancomycin and piperacillin/tazobactam, given the possibility of polymicrobial infection. Orbital CT scans revealed enhancement of the inferior and lateral rectus muscles and presence of a right orbital floor and medial wall subperiosteal abscess. There was also occlusal lucency with widening of periodontal ligament of 16 and opacification of the right maxillary sinus (Fig. 3 – 4 ). He underwent a functional endoscopic sinus surgery and subperiosteal abscess drainage. Blood cultures revealed Streptococcus constellatus, Citrobacter koseri, Streptococcus anginosus and mixed anaerobes. Progress MRI scans were performed and revealed persistent inflammation along the orbital floor, adjacent to the inferior rectus. There were no intracranial complications. At final follow up 13 months later, his vision had recovered to 6/7.5 with preservation of optic nerve function. Case 3 A 53-year-old Caucasian female presented with a 1 day history of vomiting, left periorbital swelling and vision loss. She had a broken left upper tooth 4 days prior to admission. On examination, visual acuity was no light perception in the left eye, IOP 60mmHg with an RAPD. CT orbital imaging demonstrated a left orbital floor and medial subperiosteal abscess (Fig. 5 A-C). The patient was commenced on IV ceftriaxone and metronidazole and underwent left orbital subperiosteal abscess drainage with endoscopic sinus surgery. Intraoperative swabs confirmed Streptococcus milleri with mixed anaerobic flora. The patient had persistent septicaemia and repeat CT imaging confirmed persistent subperiosteal abscesses involving all four walls of the left orbit (Fig. 5 D-E). Further drainage was performed and intraoperatively, there was extensive abscess formation and necrosis of the orbital tissue, which was debrided. Dental extraction of the upper left molar teeth (27, 28) was simultaneously performed. Despite this, the patient remained haemodynamically unstable with continued septicaemia and requiring inotropic support and intubation in ICU. Following multidisciplinary discussion regarding the extensive necrosis of orbital tissue and poor response to antibiotics despite 2 weeks of intensive treatment, the patient underwent a left orbital exenteration and external fronto-ethmoidectomy. Her systemic condition improved immediately. Within 24 hours of exenteration, she was taken off inotropic support and extubated, and was discharged 10 days later. One year post exenteration she underwent a temporalis muscle flap and closure of a naso-orbital fistula. Case 4 A 56-year-old Caucasian female was admitted to a peripheral hospital for management of left orbital cellulitis 2 weeks following dental extraction of the left upper molar tooth (26). At presentation, she had visual acuity of count fingers in the left eye, IOP 35mmHg with 8mm of proptosis and an RAPD. CT orbital imaging showed mild enlargement of the left lateral and superior recti with retrobulbar fat stranding (Fig. 6 ). She underwent an immediate lateral canthotomy and cantholysis and was admitted for commencement of IV Cephazolin and Metronidazole. The maxillofacial team performed drainage of the left ethmoid and maxillary sinuses via a Lynch incision and Caldwell Luc approach, and a swinging lid approach was performed for drainage of the orbital floor and lateral subperiosteal abscess. Wound swabs confirmed Streptococcus Milleri . The patient was slow to respond and had persistent periorbital oedema, high intraocular pressures and sepsis. She underwent repeat orbital abscess drainage and transferred to a tertiary centre. MRI orbital scans confirmed left superior and lateral orbital abscesses that demonstrated T1 hypointensity with a T2 hyperintense signal. She underwent further drainage of a residual abscess involving the ethmoid and maxillary sinuses and temporal fossa. The patient self-discharged 10 days after admission with visual acuity of count fingers. She was continued on oral Moxifloxacin and at 6 months follow-up, visual acuity had improved to 6/6. Discussion Odontogenic orbital cellulitis (OOC) represents only 3–5% of all orbital cellulitis cases but is generally associated with a poor prognosis pertaining to worse visual outcomes and increased risk of serious complications such as vision loss and cavernous sinus thrombosis [ 1 ] . This series demonstrates that patients with OOC more frequently present with an acute orbital compartment syndrome with vision loss and optic neuropathy, and the organism most commonly implicated is Streptococcus milleri . While the patients in this series did not experience any intracranial complications, repeated surgical interventions were necessary and visual prognosis was generally poor in cases secondary to Streptococcus milleri . The spread of odontogenic infection to the orbit occurs via several pathways [ 1 ] . The most common mode of spread occurs via the maxillary sinus. The buccal plate is a thin layer of bone separating the maxillary premolars and molars from the maxillary sinus and dehiscence can facilitate rapid spread into the orbit via the orbital floor. Odontogenic orbital cellulitis is typically preceded by a periapical infection of carious maxillary molars and premolars [ 26 ] . Root proximity of these dentition to the maxillary sinus floor mucosa, serves as a conduit for the passage of bacterial organisms. Spread can also occur via the retromaxillary soft tissue and extend into the infratemporal fossa, inferior orbital fissure and finally into the orbit. In particular, the proximity of this portion of the inferior orbital fissure to the orbital apex can place patients at greater risk of visual impairment. The spread of odontogenic orbital cellulitis to the surgical orbital apex, defined as the posterior 3/5 of the retrobulbar orbital space, makes for a vision-threatening condition [ 27 ] . Infectious spread to this region presents higher risk of optic nerve decompression due to the most significant decrease in volume, attesting to the important of early recognition of clinical and radiological signs. Thrombophlebitic extension to the valveless pterygoid venous plexus can result in septic emboli and cavernous sinus thrombosis. Clinical Characteristics Odontogenic orbital cellulitis can cause rapid vision loss with a poor prognosis for recovery. Youssef et al. reported 24 combined cases of odontogenic orbital cellulitis from the literature in 2008, of which 11 (45.8%) of which recorded a final vision of light perception/no light perception [ 18 ] . Similarly, of the 4 cases presented in our series, 1 (25%) recorded a final visual acuity of no light perception and one patient underwent an exenteration. The thin nature of the buccal plate which sits atop the maxillary alveolar bone promotes the rapid spread of odontogenic infections via the maxillary sinus [ 1 ] . There is great variability in time to presentation with OOC – Bullock et al., from reported ranges from 48 hours to 13 days [ 1 ] . In our series, the duration from dental infection to orbital cellulitis ranged from 24 hours to 2 weeks. The delayed presentation may be due to partial treatment with oral antibiotics soon after a dental extraction. Radiological Characteristics A hallmark radiological finding of dental infection is the presence of lucency surrounding the root apex as well as a widening of the periodontal ligament (PDL). The presence of a dental subperiosteal abscess can appear radiologically similar to periapical lucency [ 2 ] . Widening of the PDL space occurs due to the presence or spread of periodontal pathogens [ 43 ] . Additionally, carious tooth damage, which serves as an inlet of bacteria, presents as a hypoattenuation within the crown. Inflammation of the maxillary sinus can create a conduit for the spread of infection through the midface. Orbital inflammatory signs are apparent in the context of cellulitis, including extraocular muscle enlargement and retrobulbar fat stranding [ 44 ] , which was present in all patients within our series. Orbital emphysema is another radiological sign of anaerobic infection due to a path of communication between the infected maxillary sinus and orbit, allowing the spread of anaerobic bacteria such as the streptococcal species. When considering all causes of orbital cellulitis, the medial rectus is the most commonly affected muscle likely due to adjacent involvement of the ethmoid sinuses [ 45 ] (Supplementary Table 1). In contrast, half of the patients in our series presented with lateral rectus enlargement, which would be more consistent with an inferolateral pathway of pathogenic spread from the maxillary soft tissue, infratemporal fossa and inferior orbital fissure in OOC. Most Streptococcus species are facultative anaerobes and therefore can present with evidence of gas within the orbit on CT scans. Gas may be an indication of sinogenic spread of infection into the orbit, or it may be due to gas-producing organisms. Two cases (50%) in this study demonstrated orbital emphysema secondary to Streptococci milleri. In addition to anaerobic Streptococcus , other organisms implicated include Clostridium, Proteus, Klebsiella species and Escherichia coli [33, 46, 47]. Gas within the orbit has significant potential for vision loss via raised intraorbital pressure leading to tissue ischaemia and optic neuropathy [ 47 ] . Therefore, orbital emphysema is an ominous radiographic sign that should warrant concern for an aggressive organism. Magnetic resonance imaging (MRI) is superior for its delineation and monitoring of soft tissue changes and abscess formation in the brain and orbit. However, in the acute setting, access can be limited and thus CT imaging predominated as the initial imaging of choice in our series. All patients in this study eventually had an MRI scan, which showed T2 hyperintensity in the regions of involvement, which is consistent with oedema and inflammation. Management Surgical Management There are various factors that predispose patients to urgent surgical intervention. These include compromised vision, elevated IOP, proptosis greater than 5mm, unilateral maxillary sinus opacification suspicious for dental aetiology [ 28 ], [ 4 ] . Emergent canthotomy and cantholysis as well as surgical drainage was performed in all 4 of our patients. Exodontia (removal of the tooth from the underlying alveolar bone) is the optimal approach as apicectomy can lead to recurrent bacterial spread [ 48 ] . Drainage of an orbital subperiosteal abscess, and endoscopic sinus surgery is often performed concurrently to address maxillary and any additional paranasal sinusitis [ 49 ] . External approaches may also be performed for sinus drainage. In this series, the Caldwell-Luc approach and a medial Lynch incision was used to approach the maxillary and ethmoidal sinus respectively in 1 case. Furthermore, 1 patient required an orbital exenteration due to extensive necrosis of the orbital soft tissues. Visual Prognosis The average time between initial presentation to final follow-up was 18 months (range: 5–30 months) in this series. Two of the 4 patients in this study had a final visual acuity of 6/6 or 6/7.5, while the remaining half of the cohort had poor outcomes of NPL vision or requirement for an orbital exenteration. A review of the literature demonstrated that 34.5% of all patients had a final vision of LP or NPL (Supplementary Table 1). [ 1 , 2 , 5 , 18 , 25 , 38 , 39 , 50 ] Conclusion Odontogenic orbital cellulitis is a serious condition with significant potential for sight and life-threatening complications. Periapical radiolucency and widening of the periodontal ligament are concerning radiological features that suggest the presence of a dental infection. Orbital emphysema, retrobulbar fat stranding and a hyperintense T2 signal were other common radiological features. Streptococcus milleri and polymicrobial isolates are often implicated in OOC. Prompt surgical management and close surveillance for ocular, intracranial and systemic complications via a multidisciplinary approach is of the utmost importance. Abbreviations OOC – odontogenic orbital cellulitis, NPL – no perception of light, IOP – intraocular pressure, RAPD – rapid afferent pupillary defect, OPG – orthopantomogram, PDL – periodontal ligament, CT – computerised tomography, MRI – magnetic resonance imaging. Declarations Ethics approval and consent to participate Institutional review board approval was obtained from the Western Sydney Local Health District Human Research Ethics Committee. Due to the retrospective nature of the research, written informed consent was not required from patients. Consent for publication Not applicable Availability of data and materials The datasets analysed are available upon reasonable request and in compliance with local data protection policy Competing interests Not applicable Funding Not applicable Authors’ contributions Vinay Tumuluri, Dr Jessica Tong, Dr Krishna Tumuluri, and Professor Dinesh Selva wrote the main manuscript text Vinay Tumuluri, Dr Jessica Tong, Dr Krishna Tumuluri, and Professor Dinesh Selva prepared all figures and tables in the manuscript All authors reviewed the manuscript Acknowledgements Not applicable References Bullock JD, Fleishman JA (1985) The spread of odontogenic infections to the orbit: diagnosis and management. J Oral Maxillofac Surg 43(10):749–755 Caruso PA et al (2006) Odontogenic orbital inflammation: clinical and CT findings–initial observations. Radiology 239(1):187–194 Chandler JR, Langenbrunner DJ, Stevens ER (1970) The pathogenesis of orbital complications in acute sinusitis. 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Eye (Lond) 5(Pt 5):640–641 Antonio R et al (2021) Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature. Indian J Otolaryngol Head Neck Surg, : p. 1–10 Torretta S et al (2019) Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. J Clin Med, 8(1) Bullock JD, Fleishman JA (1984) Orbital cellulitis following dental extraction. Trans Am Ophthalmol Soc 82:111–133 Sharma A et al (2021) An insight on management of odontogenic orbital infections: report of two cases. J Oral Med Oral Surg 27(3):41 Tables Table 1 Clinical characteristics of OOC. Case 1 Case 2 Case 3 Case 4 Age/Gender 25/M 38/M 53/F 56/F Dental History None Exodontia of upper molar (16) Broken UL molar (27, 28) Exodontia of 26 Blood Cultures Nil growth Streptococcus constellatus Nil growth Streptococcus milleri Initial, Final Visual Acuity NPL → NPL HM → 6/7.5 NPL → N/A CF → 6/6 Causal Organism(s) wound swab S. Milleri 2+ Streptococcus constellatus S. Milleri 1+, mixed anaerobic flora 2+ Streptotoccus milleri Surgical Management Lateral canthotomy/cantholysis Exodontia of 47, drainage of dental abscess, drainage of orbital abscess via upper lid skin crease approach and lower lid transconjunctival approach Lateral canthotomy/cantholysis Orbital abscess drainage and functional endoscopic sinus surgery Lateral canthotomy/cantholysis Exodontia of 27, 28, orbital abscess drainage via functional endoscopic sinus surgery Further orbital abscess drainage and exploration + external frontoethmoidectomy Lid sparing orbital exenteration Lateral canthotomy/cantholysis Orbital subperiosteal abscess drainage + Lynch incision + Caldwell-Luc approach to drain ethmoidal and maxillary sinuses Further drainage of orbital abscess + functional endoscopic sinus surgery Further drainage of sinuses and temporal abscess via Gilles incision Number of Procedures during acute admission 1 1 3 3 Delayed Procedures Nil Nil Repair of nasoorbital medial fistula with a temporalis muscle flap Lateral canthoplasty and ectropion repair CF = count fingers; F = female; HM = hand movements; M = male; NPL = no perception of light Table 2 Radiological characteristics of OOC. Case 1 Case 2 Case 3 Case 4 CT features on admission Location of subperiosteal abscess Orbital floor, posterior lateral wall and medial wall Orbital floor and medial wall Orbital floor and roof Orbital floor, posterior lateral wall and superolateral orbit Extraocular muscle enlargement Inferior Rectus Inferior Rectus and Lateral Rectus Inferior rectus Lateral Rectus and Superior Rectus Retrobulbar fat stranding Present Present Present Present Orbital emphysema Yes Nil Nil Yes MRI features T1 weighted intensity No MRI Isointense Isointense Hypointense T2 weighted intensity Hyperintense signal along orbital floor and adjacent to the inferior rectus Hyperintensity and enlargement of inferior rectus muscle Hyperintensity of medial and lateral orbital regions Contrast enhancement Moderate None Moderate Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Published Journal Publication published 01 Oct, 2024 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted Editorial decision: Accepted 02 Aug, 2024 Reviews received at journal 28 Jul, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers invited by journal 25 Jun, 2024 Editor assigned by journal 24 Jun, 2024 Submission checks completed at journal 24 Jun, 2024 First submitted to journal 22 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4619929\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":320706341,\"identity\":\"de359c8e-d762-43e9-a264-b4f7a59615e3\",\"order_by\":0,\"name\":\"Vinay Tumuluri\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACZhiDHYgTDCR4+EGchAJCWhKgjIQCGxnJBrBeQlbBtDB8SLMxOABi4NFicJz34GfeH4ejDQ7zmH14ACSNz69OBDIY5PnFDmDXcpgvWZon4XDuBqDiGQkgjTfebpYAOsxw5uwErFokm3kM4FoYIFrObgBpSTC4jVOL8W8ULcYzzm7+gU8LPzOPGbItaTwG/L3b8NoC0mI5Jy09d+ZhtmKgMhseiRu82yyAEYTTL2z8Z4xvvLGxzu073ryZ8ccfCXv+/rObb/6osJHnl8auBQSYeFC4EmCVEjiVgwDjD1S3HsCrehSMglEwCkYeAABdxVpaIN5ZGgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"University of Adelaide\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Vinay\",\"middleName\":\"\",\"lastName\":\"Tumuluri\",\"suffix\":\"\"},{\"id\":320706342,\"identity\":\"041b4da2-336f-4e67-9292-7b5dc346e201\",\"order_by\":1,\"name\":\"Jessica Y. Tong\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Children's Hospital at Westmead, Save Sight Institute, The University of Sydney\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jessica\",\"middleName\":\"Y.\",\"lastName\":\"Tong\",\"suffix\":\"\"},{\"id\":320706343,\"identity\":\"cdef6608-fb44-45f7-9821-6e11336557bd\",\"order_by\":2,\"name\":\"Krishna Tumuluri\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The Children's Hospital at Westmead, Save Sight Institute, The University of Sydney\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Krishna\",\"middleName\":\"\",\"lastName\":\"Tumuluri\",\"suffix\":\"\"},{\"id\":320706344,\"identity\":\"0dbf4fe1-4484-4f03-89ae-724e293c2ca4\",\"order_by\":3,\"name\":\"Dinesh Selva\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Adelaide\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Dinesh\",\"middleName\":\"\",\"lastName\":\"Selva\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-06-22 04:14:13\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4619929/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4619929/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12348-024-00422-0\",\"type\":\"published\",\"date\":\"2024-10-01T15:58:27+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":60619082,\"identity\":\"2cec6d50-2c19-43d2-8553-7ee8c40a69e6\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":566678,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCase 1: OPG and CT facial bone scans. \\u003cstrong\\u003eA: \\u003c/strong\\u003eOPG image showing extensive carious damage on the crown of the lower right molar (47) and periapical radiolucency suggesting infectious spread through alveolar bone (arrows). \\u003cstrong\\u003eB-D: \\u003c/strong\\u003eThere is extensive radiolucency on 47 distal.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/614cf73668257d165af6cb67.png\"},{\"id\":60619083,\"identity\":\"9080b473-f3e7-4d4e-b606-138d5c6d1571\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":813298,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCase 1: CT orbital scans. \\u003cstrong\\u003eA: \\u003c/strong\\u003eCoronal image highlighting extensive subperiosteal abscess involving the right superolateral and inferolateral regions of the orbit. \\u003cstrong\\u003eB: \\u003c/strong\\u003eSoft tissue enhancement with alteration of the fat signal within the pterygopalatine and infratemporal fossae. \\u003cstrong\\u003eC-D:\\u003c/strong\\u003e A repeat CT orbital scan 2 days later demonstrating the presence of orbital emphysema with proptosis and tenting of the right globe.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/90c318965517334596172a63.png\"},{\"id\":60620031,\"identity\":\"5627cab0-2650-409d-a3e7-99bfd63e0b08\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:49:38\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":460292,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCase 2: The odontogenic source of infection is demonstrated on the CT facial bones imaging. \\u003cstrong\\u003eA-B:\\u003c/strong\\u003e sagittal and coronal CT images demonstrating hypoattenuation of the upper right molar (16) occlusal, and secondary opacification of right maxillary sinus.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/45d8a9a795327d5e956cbe58.png\"},{\"id\":60619085,\"identity\":\"82d2168a-e43e-4acd-a40f-49cc07d93393\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1346622,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eA-B\\u003c/strong\\u003e: CT orbital scans. There is significant right sided proptosis with retrobulbar fat stranding and a subperiosteal abscess along the medial wall and orbital floor. Opacification of the right ethmoid and maxillary sinuses are also demonstrated. \\u003cstrong\\u003eC:\\u003c/strong\\u003e MRI orbital scan performed several days following admission. T1 fat-suppressed contrast-enhanced MRI demonstrating an enlarged and enhancing right inferior rectus and avid enhancement in the region of the subperiosteal abscess. \\u003cstrong\\u003eD:\\u003c/strong\\u003e Coronal T2 image shows hyperintensity of the right inferior rectus and adjacent subperiosteal abscess collection.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/7f57e80c9296f2b9c8e7224e.png\"},{\"id\":60619086,\"identity\":\"01b132c2-93a9-43b4-99d8-965ac5d3c27d\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":842702,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCase 3: \\u003cstrong\\u003eA-B: \\u003c/strong\\u003eCoronal CT image demonstrating subperiosteal collection along the left medial wall, orbital floor and lateral wall.\\u003cstrong\\u003e C: \\u003c/strong\\u003eAxial CT image demonstrating significant tenting of the left globe. \\u003cstrong\\u003eD-E:\\u003c/strong\\u003e A repeat CT orbital scan revealed persistent circumferential subperiosteal collections of the left orbit.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/648b57776c29bae01a24525a.png\"},{\"id\":60619087,\"identity\":\"4269a4e6-2e5c-463e-bce1-716fe431db35\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"png\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":825964,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCase 4: \\u003cstrong\\u003eA: \\u003c/strong\\u003eMRI image demonstrating left sided proptosis with tenting of the globe. \\u003cstrong\\u003eB-C:\\u003c/strong\\u003eThere is an abscess centred around the left superolateral and inferior orbit that is T1 isointense and T2 hyperintense, with associated enlargement and oedema of the lateral and inferior recti.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"6.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/f51b1283f45cbcb5b7b95cf3.png\"},{\"id\":66097030,\"identity\":\"f5431b57-cc08-4365-9c88-903a7ded0b7b\",\"added_by\":\"auto\",\"created_at\":\"2024-10-07 16:12:52\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":5621470,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/31e3f9d0-963c-4866-8962-8df99d9d3da2.pdf\"},{\"id\":60619081,\"identity\":\"856d3e9a-3661-444a-bd16-d993ee1dc4ee\",\"added_by\":\"auto\",\"created_at\":\"2024-07-18 20:41:38\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":54425,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryTable1.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4619929/v1/607810aec62d103b31e37fa4.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Clinical and radiological characteristics of odontogenic orbital cellulitis\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eOdontogenic orbital cellulitis (OOC) represents 3\\u0026ndash;5% of orbital cellulitis cases\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e, and tends to have a poor clinical course with complications including vision loss, septicaemia and cavernous sinus thrombosis \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e. The route for odontogenic spread of infection to the orbit can occur via the maxillary premolars and molars or spread via the infratemporal fossa up into the inferior orbital fissure. Oral pathogens are more likely to be associated with anaerobic organisms and the lack of empirical antibiotic coverage combined with its inherent virulence may result in more adverse outcomes. Therefore, prompt recognition of OOC is crucial to direct appropriate antimicrobial treatment and timing of surgical drainage. The existing literature is predominated by case reports highlighting the broad and unique microbiological profile of odontogenic organisms and associated vision loss \\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e. This study presents a case series of 4 patients with OOC while examining the microbiological profile, clinico-radiological features and ophthalmic outcomes.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThe authors performed a retrospective study of patients admitted with OOC at major tertiary referral centres in Sydney and Adelaide, Australia. Study variables included data on demographics (age, sex, pre-existing medical conditions), ophthalmic findings (visual acuity, intraocular pressure, proptosis, dystopia, optic neuropathy), details of the odontogenic infection (dental procedure, intravenous/oral antibiotic use), investigations (fever, leukocytosis, inflammatory markers, blood cultures), radiographic findings (CT and MRI) and management. Institutional ethics approval was obtained and the study followed the tenets of Declaration of Helsinki.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe clinical summary of each case is presented below and further summarised in Tables\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e and \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. A literature review of all published reports of odontogenic orbital cellulitis is provided in Supplementary Table\\u0026nbsp;1.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eCase Presentations\\u003c/h2\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCase 1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eA 25-year-old Caucasian male was admitted with a 3 day history of right tooth and jaw pain with progressive periorbital oedema. On examination, visual acuity of the right eye was no perception of light (NPL) with raised intraocular pressure (IOP) of 50mmHg, 6mm of proptosis and a relative afferent pupillary defect (RAPD). Orthopantomogram (OPG) showed an abscess of the second lower right molar (47) with periapical lucency and widening of the periodontal ligament (PDL) space (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). CT orbital scans demonstrated an extensive subperiosteal abscess of the right orbital floor, lateral wall, and roof with soft tissue enhancement of the infratemporal fossa and parapharyngeal space. A lateral canthotomy and cantholysis was performed. The patient underwent urgent drainage of the subperiosteal abscess in conjunction with extraction of the right molar tooth (47) and drainage of the dental abscess. Intraoperative orbital swabs showed growth of \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e sensitive to penicillin. The patient was treated with a combination of IV ceftriaxone, vancomycin, tazocin and meropenem. He was discharged 12 days post-admission with no improvement in vision. At 5 months follow-up, the right eye vision remained no light perception with evidence of optic atrophy.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCase 2\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eA 38-year-old Chinese man presented with a 1 day history of right eye pain, periocular swelling and erythema. The patient had extraction of an upper right molar tooth (16) 1 day prior and presented with almost complete ophthalmoplegia. On presentation, his visual acuity was hand movements with an IOP of 45 mmHg. Orbital compartment syndrome necessitated an emergent lateral canthotomy. Under the guidance of Infectious Diseases, he was commenced on IV amoxicillin/clavulanic acid and metronidazole on admission and within 24 hours was changed to vancomycin and piperacillin/tazobactam, given the possibility of polymicrobial infection. Orbital CT scans revealed enhancement of the inferior and lateral rectus muscles and presence of a right orbital floor and medial wall subperiosteal abscess. There was also occlusal lucency with widening of periodontal ligament of 16 and opacification of the right maxillary sinus (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). He underwent a functional endoscopic sinus surgery and subperiosteal abscess drainage. Blood cultures revealed \\u003cem\\u003eStreptococcus constellatus, Citrobacter koseri, Streptococcus anginosus\\u003c/em\\u003e and mixed anaerobes. Progress MRI scans were performed and revealed persistent inflammation along the orbital floor, adjacent to the inferior rectus. There were no intracranial complications. At final follow up 13 months later, his vision had recovered to 6/7.5 with preservation of optic nerve function.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCase 3\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eA 53-year-old Caucasian female presented with a 1 day history of vomiting, left periorbital swelling and vision loss. She had a broken left upper tooth 4 days prior to admission. On examination, visual acuity was no light perception in the left eye, IOP 60mmHg with an RAPD. CT orbital imaging demonstrated a left orbital floor and medial subperiosteal abscess (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003eA-C). The patient was commenced on IV ceftriaxone and metronidazole and underwent left orbital subperiosteal abscess drainage with endoscopic sinus surgery. Intraoperative swabs confirmed \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e with mixed anaerobic flora. The patient had persistent septicaemia and repeat CT imaging confirmed persistent subperiosteal abscesses involving all four walls of the left orbit (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003eD-E). Further drainage was performed and intraoperatively, there was extensive abscess formation and necrosis of the orbital tissue, which was debrided. Dental extraction of the upper left molar teeth (27, 28) was simultaneously performed. Despite this, the patient remained haemodynamically unstable with continued septicaemia and requiring inotropic support and intubation in ICU. Following multidisciplinary discussion regarding the extensive necrosis of orbital tissue and poor response to antibiotics despite 2 weeks of intensive treatment, the patient underwent a left orbital exenteration and external fronto-ethmoidectomy. Her systemic condition improved immediately. Within 24 hours of exenteration, she was taken off inotropic support and extubated, and was discharged 10 days later. One year post exenteration she underwent a temporalis muscle flap and closure of a naso-orbital fistula.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCase 4\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eA 56-year-old Caucasian female was admitted to a peripheral hospital for management of left orbital cellulitis 2 weeks following dental extraction of the left upper molar tooth (26). At presentation, she had visual acuity of count fingers in the left eye, IOP 35mmHg with 8mm of proptosis and an RAPD. CT orbital imaging showed mild enlargement of the left lateral and superior recti with retrobulbar fat stranding (Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e). She underwent an immediate lateral canthotomy and cantholysis and was admitted for commencement of IV Cephazolin and Metronidazole. The maxillofacial team performed drainage of the left ethmoid and maxillary sinuses via a Lynch incision and Caldwell Luc approach, and a swinging lid approach was performed for drainage of the orbital floor and lateral subperiosteal abscess. Wound swabs confirmed \\u003cem\\u003eStreptococcus Milleri\\u003c/em\\u003e. The patient was slow to respond and had persistent periorbital oedema, high intraocular pressures and sepsis. She underwent repeat orbital abscess drainage and transferred to a tertiary centre. MRI orbital scans confirmed left superior and lateral orbital abscesses that demonstrated T1 hypointensity with a T2 hyperintense signal. She underwent further drainage of a residual abscess involving the ethmoid and maxillary sinuses and temporal fossa. The patient self-discharged 10 days after admission with visual acuity of count fingers. She was continued on oral Moxifloxacin and at 6 months follow-up, visual acuity had improved to 6/6.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eOdontogenic orbital cellulitis (OOC) represents only 3\\u0026ndash;5% of all orbital cellulitis cases but is generally associated with a poor prognosis pertaining to worse visual outcomes and increased risk of serious complications such as vision loss and cavernous sinus thrombosis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. This series demonstrates that patients with OOC more frequently present with an acute orbital compartment syndrome with vision loss and optic neuropathy, and the organism most commonly implicated is \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e. While the patients in this series did not experience any intracranial complications, repeated surgical interventions were necessary and visual prognosis was generally poor in cases secondary to \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe spread of odontogenic infection to the orbit occurs via several pathways \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. The most common mode of spread occurs via the maxillary sinus. The buccal plate is a thin layer of bone separating the maxillary premolars and molars from the maxillary sinus and dehiscence can facilitate rapid spread into the orbit via the orbital floor. Odontogenic orbital cellulitis is typically preceded by a periapical infection of carious maxillary molars and premolars \\u003csup\\u003e[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. Root proximity of these dentition to the maxillary sinus floor mucosa, serves as a conduit for the passage of bacterial organisms. Spread can also occur via the retromaxillary soft tissue and extend into the infratemporal fossa, inferior orbital fissure and finally into the orbit. In particular, the proximity of this portion of the inferior orbital fissure to the orbital apex can place patients at greater risk of visual impairment. The spread of odontogenic orbital cellulitis to the surgical orbital apex, defined as the posterior 3/5 of the retrobulbar orbital space, makes for a vision-threatening condition \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e. Infectious spread to this region presents higher risk of optic nerve decompression due to the most significant decrease in volume, attesting to the important of early recognition of clinical and radiological signs. Thrombophlebitic extension to the valveless pterygoid venous plexus can result in septic emboli and cavernous sinus thrombosis.\\u003c/p\\u003e\\n\\u003ch3\\u003eClinical Characteristics\\u003c/h3\\u003e\\n\\u003cp\\u003eOdontogenic orbital cellulitis can cause rapid vision loss with a poor prognosis for recovery. Youssef et al. reported 24 combined cases of odontogenic orbital cellulitis from the literature in 2008, of which 11 (45.8%) of which recorded a final vision of light perception/no light perception \\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. Similarly, of the 4 cases presented in our series, 1 (25%) recorded a final visual acuity of no light perception and one patient underwent an exenteration.\\u003c/p\\u003e \\u003cp\\u003eThe thin nature of the buccal plate which sits atop the maxillary alveolar bone promotes the rapid spread of odontogenic infections via the maxillary sinus \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. There is great variability in time to presentation with OOC \\u0026ndash; Bullock et al., from reported ranges from 48 hours to 13 days \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]\\u003c/sup\\u003e. In our series, the duration from dental infection to orbital cellulitis ranged from 24 hours to 2 weeks. The delayed presentation may be due to partial treatment with oral antibiotics soon after a dental extraction.\\u003c/p\\u003e\\n\\u003ch3\\u003eRadiological Characteristics\\u003c/h3\\u003e\\n\\u003cp\\u003eA hallmark radiological finding of dental infection is the presence of lucency surrounding the root apex as well as a widening of the periodontal ligament (PDL). The presence of a dental subperiosteal abscess can appear radiologically similar to periapical lucency \\u003csup\\u003e[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. Widening of the PDL space occurs due to the presence or spread of periodontal pathogens\\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, carious tooth damage, which serves as an inlet of bacteria, presents as a hypoattenuation within the crown.\\u003c/p\\u003e \\u003cp\\u003eInflammation of the maxillary sinus can create a conduit for the spread of infection through the midface. Orbital inflammatory signs are apparent in the context of cellulitis, including extraocular muscle enlargement and retrobulbar fat stranding \\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e, which was present in all patients within our series. Orbital emphysema is another radiological sign of anaerobic infection due to a path of communication between the infected maxillary sinus and orbit, allowing the spread of anaerobic bacteria such as the streptococcal species. When considering all causes of orbital cellulitis, the medial rectus is the most commonly affected muscle likely due to adjacent involvement of the ethmoid sinuses \\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]\\u003c/sup\\u003e (Supplementary Table\\u0026nbsp;1). In contrast, half of the patients in our series presented with lateral rectus enlargement, which would be more consistent with an inferolateral pathway of pathogenic spread from the maxillary soft tissue, infratemporal fossa and inferior orbital fissure in OOC.\\u003c/p\\u003e \\u003cp\\u003eMost \\u003cem\\u003eStreptococcus\\u003c/em\\u003e species are facultative anaerobes and therefore can present with evidence of gas within the orbit on CT scans. Gas may be an indication of sinogenic spread of infection into the orbit, or it may be due to gas-producing organisms. Two cases (50%) in this study demonstrated orbital emphysema secondary to \\u003cem\\u003eStreptococci milleri.\\u003c/em\\u003e In addition to anaerobic \\u003cem\\u003eStreptococcus\\u003c/em\\u003e, other organisms implicated include \\u003cem\\u003eClostridium, Proteus, Klebsiella\\u003c/em\\u003e species and \\u003cem\\u003eEscherichia coli [33, 46, 47].\\u003c/em\\u003e Gas within the orbit has significant potential for vision loss via raised intraorbital pressure leading to tissue ischaemia and optic neuropathy \\u003csup\\u003e[\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, orbital emphysema is an ominous radiographic sign that should warrant concern for an aggressive organism.\\u003c/p\\u003e \\u003cp\\u003eMagnetic resonance imaging (MRI) is superior for its delineation and monitoring of soft tissue changes and abscess formation in the brain and orbit. However, in the acute setting, access can be limited and thus CT imaging predominated as the initial imaging of choice in our series. All patients in this study eventually had an MRI scan, which showed T2 hyperintensity in the regions of involvement, which is consistent with oedema and inflammation.\\u003c/p\\u003e\\n\\u003ch3\\u003eManagement\\u003c/h3\\u003e\\n\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSurgical Management\\u003c/h2\\u003e \\u003cp\\u003eThere are various factors that predispose patients to urgent surgical intervention. These include compromised vision, elevated IOP, proptosis greater than 5mm, unilateral maxillary sinus opacification suspicious for dental aetiology \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e], [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. Emergent canthotomy and cantholysis as well as surgical drainage was performed in all 4 of our patients. Exodontia (removal of the tooth from the underlying alveolar bone) is the optimal approach as apicectomy can lead to recurrent bacterial spread \\u003csup\\u003e[\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e. Drainage of an orbital subperiosteal abscess, and endoscopic sinus surgery is often performed concurrently to address maxillary and any additional paranasal sinusitis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e]\\u003c/sup\\u003e. External approaches may also be performed for sinus drainage. In this series, the Caldwell-Luc approach and a medial Lynch incision was used to approach the maxillary and ethmoidal sinus respectively in 1 case. Furthermore, 1 patient required an orbital exenteration due to extensive necrosis of the orbital soft tissues.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eVisual Prognosis\\u003c/h2\\u003e \\u003cp\\u003eThe average time between initial presentation to final follow-up was 18 months (range: 5\\u0026ndash;30 months) in this series. Two of the 4 patients in this study had a final visual acuity of 6/6 or 6/7.5, while the remaining half of the cohort had poor outcomes of NPL vision or requirement for an orbital exenteration. A review of the literature demonstrated that 34.5% of all patients had a final vision of LP or NPL (Supplementary Table\\u0026nbsp;1). \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eOdontogenic orbital cellulitis is a serious condition with significant potential for sight and life-threatening complications. Periapical radiolucency and widening of the periodontal ligament are concerning radiological features that suggest the presence of a dental infection. Orbital emphysema, retrobulbar fat stranding and a hyperintense T2 signal were other common radiological features. \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e and polymicrobial isolates are often implicated in OOC. Prompt surgical management and close surveillance for ocular, intracranial and systemic complications via a multidisciplinary approach is of the utmost importance.\\u003c/p\\u003e \"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eOOC \\u0026ndash; odontogenic orbital cellulitis, NPL \\u0026ndash; no perception of light, IOP \\u0026ndash; intraocular pressure, RAPD \\u0026ndash; rapid afferent pupillary defect, OPG \\u0026ndash; orthopantomogram, PDL \\u0026ndash; periodontal ligament, CT \\u0026ndash; computerised tomography, MRI \\u0026ndash; magnetic resonance imaging.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eInstitutional review board approval was obtained from the Western Sydney Local Health District Human Research Ethics Committee. Due to the retrospective nature of the research, written informed consent was not required from patients.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNot applicable\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThe datasets analysed are available upon reasonable request and in compliance with local data protection policy\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNot applicable\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNot applicable\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eVinay Tumuluri, Dr Jessica Tong, Dr Krishna Tumuluri, and Professor Dinesh Selva wrote the main manuscript text\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eVinay Tumuluri, Dr Jessica Tong, Dr Krishna Tumuluri, and Professor Dinesh Selva prepared all figures and tables in the manuscript \\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAll authors reviewed the manuscript\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNot applicable \\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBullock JD, Fleishman JA (1985) The spread of odontogenic infections to the orbit: diagnosis and management. J Oral Maxillofac Surg 43(10):749\\u0026ndash;755\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCaruso PA et al (2006) Odontogenic orbital inflammation: clinical and CT findings\\u0026ndash;initial observations. Radiology 239(1):187\\u0026ndash;194\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChandler JR, Langenbrunner DJ, Stevens ER (1970) The pathogenesis of orbital complications in acute sinusitis. Laryngoscope 80(9):1414\\u0026ndash;1428\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAllegrini D et al (2017) Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report. J Med Case Rep 11(1):164\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSheils CR, Cypen SG, Tao JP (2021) Blindness Secondary to Odontogenic Orbital Cellulitis During the COVID-19 Dental Shutdown. Ophthalmic Plast Reconstr Surg 37(5):e194\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWhite M et al (2021) Neonatal tooth infection resulting in subperiosteal orbital abscess: A case report. Int J Pediatr Otorhinolaryngol 140:110524\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRothschild MI, Pinheiro-Neto CD, Rubinstein TJ (2020) Odontogenic Abscess With Orbital Extension Through the Inferior Orbital Fissure Treated With Bony Decompression. Ophthalmic Plast Reconstr Surg 36(5):e131\\u0026ndash;e134\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEltayeb AS, Karrar MA, Elbeshir EI (2019) Orbital Subperiosteal Abscess Associated with Mandibular Wisdom Tooth Infection: A Case Report. J Maxillofac Oral Surg 18(1):30\\u0026ndash;33\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStead TG et al (2019) Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus 11(7):e5087\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLi E, Distefano A, Sohrab M (2018) Necrotizing Orbital Cellulitis Secondary to Odontogenic Streptococcus constellatus. Ophthalmic Plast Reconstr Surg 34(5):e160\\u0026ndash;e162\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMansour AM et al (2017) \\u003cem\\u003eOdontogenic abscess mimicking acute dacryocystitis.\\u003c/em\\u003e BMJ Case Rep, 2017\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVu Q, Dyer G, Kunjukunju N (2015) A rare case of odontogenic parainfectious intraorbital optic neuritis with the absence of clinical manifestation of orbital cellulitis. Retin Cases Brief Rep 9(3):205\\u0026ndash;209\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArunkumar KV (2016) Orbital Infection Threatening Blindness Due to Carious Primary Molars: An Interesting Case Report. J Maxillofac Oral Surg 15(1):72\\u0026ndash;75\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eProcacci P et al (2017) Odontogenic orbital abscess: a case report and review of literature. Oral Maxillofac Surg 21(2):271\\u0026ndash;279\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTavakoli M et al (2013) Orbital cellulitis as a complication of mandibular odontogenic infection. Ophthalmic Plast Reconstr Surg 29(1):e5\\u0026ndash;7\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePark CH, Jee DH, La TY (2013) A case of odontogenic orbital cellulitis causing blindness by severe tension orbit. J Korean Med Sci 28(2):340\\u0026ndash;343\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ede Medeiros EH et al (2012) Orbital abscess during endodontic treatment: a case report. J Endod 38(11):1541\\u0026ndash;1543\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYoussef OH, Stefanyszyn MA, Bilyk JR (2008) Odontogenic orbital cellulitis. Ophthalmic Plast Reconstr Surg 24(1):29\\u0026ndash;35\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThakar M, Thakar A (2009) Odontogenic orbital cellulitis. Acta Ophthalmol Scand 73(5):470\\u0026ndash;471\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThakar M, Thakar A (1995) Odontogenic orbital cellulitis. Report of a case and considerations on route of spread. Acta Ophthalmol Scand 73(5):470\\u0026ndash;471\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAllan BP, Egbert MA, Myall RW (1991) Orbital abscess of odontogenic origin. Case report and review of the literature. Int J Oral Maxillofac Surg 20(5):268\\u0026ndash;270\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoswami P, Ie A, O'Donnell BA (2021) Orbital cellulitis and osteomyelitis secondary to odontogenic infection with campylobacter rectus: a case report. Orbit, : p. 1\\u0026ndash;3\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGrimes D, Fan K, Huppa C (2006) Case report: dental infection leading to orbital cellulitis. Dent Update 33(4):217\\u0026ndash;218\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBlumenthal DS, Powell O (1985) Orbital cellulitis and sinusitis caused by group B beta streptococcus in a 3-year-old child. J Natl Med Assoc 77(2):147\\u0026ndash;148\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArat YO, Shetlar DJ, Rose JE (2004) Blindness from septic thrombophlebitis of the orbit and cavernous sinus caused by Fusobacterium nucleatum. Arch Ophthalmol 122(4):652\\u0026ndash;654\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAntonio R et al (2022) Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature. Indian J Otolaryngol Head Neck Surg 74(Suppl 3):4552\\u0026ndash;4561\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZurinam O et al (2021) CT definition of the surgical apex in the orbit. Sci Rep 11(1):11016\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTsirouki T et al (2018) Orbital cellulitis. Surv Ophthalmol 63(4):534\\u0026ndash;553\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eUmeshappa H et al (2021) Microbiological profile of aerobic and anaerobic bacteria and its clinical significance in antibiotic sensitivity of odontogenic space infection: A prospective study of 5 years. Natl J Maxillofac Surg 12(3):372\\u0026ndash;379\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eErazo D, Whetstone DR (2021) Dental Infections. StatPearls. Treasure Island (FL)\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYan W et al (2015) Orbital Cellulitis of Odontogenic Origin. Orbit 34(4):183\\u0026ndash;185\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOgundiya DA, Keith DA, Mirowski J (1989) Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature. J Oral Maxillofac Surg 47(12):1317\\u0026ndash;1321\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFlood TP et al (1982) Computed tomography in the management of orbital infections associated with dental disease. Br J Ophthalmol 66(4):269\\u0026ndash;274\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHenry CH, Hughes CV, Larned DC (1992) Odontogenic infection of the orbit: report of a case. J Oral Maxillofac Surg 50(2):172\\u0026ndash;178\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJanakarajah N, Sukumaran K (1985) Orbital cellulitis of dental origin: case report and review of the literature. Br J Oral Maxillofac Surg 23(2):140\\u0026ndash;145\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBizakis JG et al (1997) Transantral evacuation of an orbital abscess following a molar tooth extraction. Am J Otolaryngol 18(4):277\\u0026ndash;279\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePavlovich P, Looi A, Rootman J (2006) Septic thrombosis of the cavernous sinus: two different mechanisms. Orbit 25(1):39\\u0026ndash;43\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMoschos MM et al (2005) Visual loss due to a carious tooth. Lancet 366(9495):1504\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePatt BS, Manning SC (1991) Blindness resulting from orbital complications of sinusitis. Otolaryngol Head Neck Surg 104(6):789\\u0026ndash;795\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBahl R et al (2014) Odontogenic infections: Microbiology and management. Contemp Clin Dent 5(3):307\\u0026ndash;311\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGossling J (1988) Occurrence and pathogenicity of the Streptococcus milleri group. Rev Infect Dis 10(2):257\\u0026ndash;285\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOlson AB et al (2013) Phylogenetic relationship and virulence inference of Streptococcus Anginosus Group: curated annotation and whole-genome comparative analysis support distinct species designation. BMC Genomics 14:895\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMortazavi H, Baharvand M (2016) Review of common conditions associated with periodontal ligament widening. Imaging Sci Dent 46(4):229\\u0026ndash;237\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMombaerts I, Rose GE, Verity DH (2017) Diagnosis of enlarged extraocular muscles: when and how to biopsy. Curr Opin Ophthalmol 28(5):514\\u0026ndash;521\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLakerveld M, Van Der Gijp A (2022) Orbital Muscle Enlargement: What if It\\u0026rsquo;s Not Graves\\u0026rsquo; Disease? Curr Radiol Rep 10(2):9\\u0026ndash;19\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSevel D et al (1973) Gas in the orbit associated with orbital cellulitis and paranasal sinusitis. Br J Ophthalmol 57(2):133\\u0026ndash;137\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRose GE et al (1991) Acute orbital cellulitis due to gas-forming bacteria. Eye (Lond) 5(Pt 5):640\\u0026ndash;641\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAntonio R et al (2021) Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature. Indian J Otolaryngol Head Neck Surg, : p. 1\\u0026ndash;10\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTorretta S et al (2019) Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. J Clin Med, 8(1)\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBullock JD, Fleishman JA (1984) Orbital cellulitis following dental extraction. Trans Am Ophthalmol Soc 82:111\\u0026ndash;133\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSharma A et al (2021) An insight on management of odontogenic orbital infections: report of two cases. J Oral Med Oral Surg 27(3):41\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical characteristics of OOC.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar5\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar6\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar7\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar8\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge/Gender\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25/M\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38/M\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53/F\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e56/F\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDental History\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eExodontia of upper molar (16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eBroken UL molar (27, 28)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eExodontia of 26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBlood Cultures\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNil growth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eStreptococcus constellatus\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNil growth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eInitial, Final Visual Acuity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNPL \\u0026rarr; NPL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHM \\u0026rarr; 6/7.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNPL \\u0026rarr; N/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCF \\u0026rarr; 6/6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCausal Organism(s) wound swab\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eS. Milleri 2+\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eStreptococcus constellatus\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eS. Milleri 1+, mixed anaerobic flora 2+\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eStreptotoccus milleri\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSurgical Management\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLateral canthotomy/cantholysis\\u003c/p\\u003e \\u003cp\\u003eExodontia of 47, drainage of dental abscess, drainage of orbital abscess via upper lid skin crease approach and lower lid transconjunctival approach\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eLateral canthotomy/cantholysis\\u003c/p\\u003e \\u003cp\\u003eOrbital abscess drainage and functional endoscopic sinus surgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eLateral canthotomy/cantholysis\\u003c/p\\u003e \\u003cp\\u003eExodontia of 27, 28, orbital abscess drainage via functional endoscopic sinus surgery\\u003c/p\\u003e \\u003cp\\u003eFurther orbital abscess drainage and exploration\\u0026thinsp;+\\u0026thinsp;external frontoethmoidectomy\\u003c/p\\u003e \\u003cp\\u003eLid sparing orbital exenteration\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLateral canthotomy/cantholysis\\u003c/p\\u003e \\u003cp\\u003eOrbital subperiosteal abscess drainage\\u0026thinsp;+\\u0026thinsp;Lynch incision\\u0026thinsp;+\\u0026thinsp;Caldwell-Luc approach to drain ethmoidal and maxillary sinuses\\u003c/p\\u003e \\u003cp\\u003eFurther drainage of orbital abscess\\u0026thinsp;+\\u0026thinsp;functional endoscopic sinus surgery\\u003c/p\\u003e \\u003cp\\u003eFurther drainage of sinuses and temporal abscess via Gilles incision\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNumber of Procedures during acute admission\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDelayed Procedures\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNil\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNil\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRepair of nasoorbital medial fistula with a temporalis muscle flap\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLateral canthoplasty and ectropion repair\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eCF\\u0026thinsp;=\\u0026thinsp;count fingers; F\\u0026thinsp;=\\u0026thinsp;female; HM\\u0026thinsp;=\\u0026thinsp;hand movements; M\\u0026thinsp;=\\u0026thinsp;male; NPL\\u0026thinsp;=\\u0026thinsp;no perception of light\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eRadiological characteristics of OOC.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar5\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar6\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar7\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCase \\u003cspan refid=\\\"FPar8\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCT features on admission\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLocation of subperiosteal abscess\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOrbital floor, posterior lateral wall and medial wall\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOrbital floor and medial wall\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eOrbital floor and roof\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eOrbital floor, posterior lateral wall and superolateral orbit\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eExtraocular muscle enlargement\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eInferior Rectus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eInferior Rectus and Lateral Rectus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eInferior rectus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLateral Rectus and Superior Rectus\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRetrobulbar fat stranding\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ePresent\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eOrbital emphysema\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNil\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNil\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eMRI features\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eT1 weighted intensity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eNo MRI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eIsointense\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eIsointense\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHypointense\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eT2 weighted intensity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHyperintense signal along orbital floor and adjacent to the inferior rectus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eHyperintensity and enlargement of inferior rectus muscle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eHyperintensity of medial and lateral orbital regions\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eContrast enhancement\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-ophthalmic-inflammation-and-infection\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"joii\",\"sideBox\":\"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)\",\"snPcode\":\"12348\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12348/3\",\"title\":\"Journal of Ophthalmic Inflammation and Infection\",\"twitterHandle\":\"@SpringerOpen\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4619929/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4619929/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003ePurpose: \\u003c/strong\\u003eTo assess the radiological features and clinical outcomes of odontogenic orbital cellulitis\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethod:\\u003c/strong\\u003e Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eFour 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).\\u003c/p\\u003e\\n\\u003cp\\u003eAll 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 \\u003cem\\u003eStreptococcus milleri\\u003c/em\\u003e (n=3, 75%) and\\u003cem\\u003e Streptococcus constellatus\\u003c/em\\u003e (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.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eOdontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to \\u003cem\\u003eStreptococcus \\u003c/em\\u003especies.\\u003cstrong\\u003e \\u003c/strong\\u003eOutcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Clinical and radiological characteristics of odontogenic orbital cellulitis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-18 20:41:33\",\"doi\":\"10.21203/rs.3.rs-4619929/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Accepted\",\"date\":\"2024-08-02T18:47:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-07-28T06:50:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"112647711744474638937908151477350036962\",\"date\":\"2024-07-28T06:33:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-06-25T05:34:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-06-24T10:03:22+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-06-24T10:02:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Journal of Ophthalmic Inflammation and Infection\",\"date\":\"2024-06-22T04:12:29+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-ophthalmic-inflammation-and-infection\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"joii\",\"sideBox\":\"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)\",\"snPcode\":\"12348\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12348/3\",\"title\":\"Journal of Ophthalmic Inflammation and Infection\",\"twitterHandle\":\"@SpringerOpen\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"804e7251-8c78-46a7-80ed-da4ae042dbba\",\"owner\":[],\"postedDate\":\"July 18th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-10-07T16:06:22+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4619929\",\"link\":\"https://doi.org/10.1186/s12348-024-00422-0\",\"journal\":{\"identity\":\"journal-of-ophthalmic-inflammation-and-infection\",\"isVorOnly\":false,\"title\":\"Journal of Ophthalmic Inflammation and Infection\"},\"publishedOn\":\"2024-10-01 15:58:27\",\"publishedOnDateReadable\":\"October 1st, 2024\"},\"versionCreatedAt\":\"2024-07-18 20:41:33\",\"video\":\"\",\"vorDoi\":\"10.1186/s12348-024-00422-0\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12348-024-00422-0\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4619929\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4619929\",\"identity\":\"rs-4619929\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}