Orbital Cellulitis as a Complication of Acute Rhinosinusitis of Odontogenic Origin in a patient with Amelogenesis Imperfecta: A Case Report and Literature Review

Orbital Cellulitis as a Complication of Acute Rhinosinusitis of Odontogenic Origin in a patient with Amelogenesis Imperfecta: A Case Report and Literature Review | 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 Case Report Orbital Cellulitis as a Complication of Acute Rhinosinusitis of Odontogenic Origin in a patient with Amelogenesis Imperfecta: A Case Report and Literature Review Thinley Thinley, Sandip Tamang, Sonam Choden Tshering, Tshewang Lhamo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8628068/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Orbital cellulitis is a potentially sight- and life-threatening condition most commonly secondary to acute rhinosinusitis. Odontogenic orbital cellulitis is rare and often under-recognized, with nonspecific presentations that may delay diagnosis. Prompt identification and multidisciplinary management are critical to prevent visual and systemic complications. We present a case of orbital cellulitis as a complication of acute rhinosinusitis of odontogenic origin in a patient with amelogenesis imperfecta. Case presentation A 27-year-old female with amelogenesis imperfecta presented with progressive left periorbital swelling, pain, and decreased vision over five days’ duration. She reported suffering from toothache a few days prior to ocular symptoms. Clinical evaluation and imaging revealed pre-septal and orbital cellulitis secondary to acute rhinosinusitis of odontogenic origin, complicated by subperiosteal abscess formation. Immediate surgical intervention included endoscopic sinus debridement and incision and drainage of preseptal abscess followed by the extraction of the culprit tooth. Concurrent use of intravenous antibiotics led to complete resolution of symptoms with preservation of vision. Conclusions This case underscores the necessity of early recognition of odontogenic sources of orbital cellulitis and the critical role of coordinated multidisciplinary management. Prompt surgical drainage and targeted therapy can lead to favorable visual and systemic outcomes, even in severe presentations. Orbital cellulitis acute rhinosinusitis odontogenic origin amelogenesis imperfect interdisciplinary collaboration Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background The anatomical proximity of the orbit to the paranasal sinuses and oral cavity renders it vulnerable to contiguous spread of infections originating in these regions. Orbital cellulitis is a potentially sight- and life-threatening condition characterized by infection of the soft tissues posterior to the orbital septum. It most commonly arises as a complication of acute rhinosinusitis, accounting for up to 75% of cases, particularly in pediatric populations [ 1 , 2 ]. However, odontogenic orbital cellulitis—where the primary source of infection originates from the maxillary teeth or surrounding structures—is a rare and under-recognized entity [ 3 – 5 ]. Odontogenic infections may spread to the orbit through direct bony erosion, perivascular channels, or hematogenous routes [ 6 ]. The clinical presentation can be insidious and nonspecific, often mimicking other orbital or sinus pathologies, thereby posing diagnostic and therapeutic challenges. Timely recognition and a multidisciplinary approach are crucial to avoid complications such as vision loss, intracranial extension, and systemic sepsis [ 7 ]. We present a rare case of orbital cellulitis and subperiosteal abscess secondary to acute rhinosinusitis of odontogenic origin in a young adult female with amelogenesis imperfecta—a genetic enamel defect associated with increased risk of dental decay. This case highlights the diagnostic complexities and emphasizes the importance of coordinated management involving ophthalmology, otolaryngology, radiology and dental specialties. Case Presentation A 27-year-old female, with amelogenesis imperfecta, presented to the emergency department with five days’ history of worsening left periorbital swelling, redness and pain associated with eye movement. With progressive eyelid swelling and protrusion of eyeball the patient started to experience slight diminution of vision accompanied by double vision. The patient reported experiencing toothache preceding the onset of orbital symptoms. She has a history of dental cavities on the ipsilateral side of orbital swelling. Upon further inquiry, she denied fever or any neurological symptoms. Past medical history was unremarkable for immunocompromising conditions or chronic sinus disease. Figure 1 Clinical photo at presentation showing marked left periorbital swelling and erythema with complete ptosis. On examination, the patient appeared acutely ill, with pronounced left periorbital swelling, tenderness, and erythema. Conjunctival injection and chemosis were noted in the affected eye, with associated proptosis and complete ptosis ( Fig. 1 ). Her visual acuity was 6/6 and 6/36 in the right and left eye respectively, with no relative afferent pupillary defect. Intraocular pressure was 20 and 53 mmHg in the right and left eye respectively. Extra ocular movements in the affected eye were limited in all gazes, notably restricted on upward and medial gaze with complaint of pain on eye movement. Posterior segment examination was unremarkable. Figure 2 Endoscopic nasal examination showing edematous nasal mucosa with pus discharge from middle meatus. Figure footnotes: MT – Middle Turbinate; S -Nasal Septum; IT -Inferior Turbinate; Nasal endoscopy performed by ENT (Ear, Nose and Throat) Surgeon showed edematous left middle turbinate with the presence of necrotic tissue along with mucopurulent discharge (Fig. 2) . Examination of right nasal cavity and the neck, ears and oral cavity were unremarkable. Diagnosis of acute rhinosinusitis was made following which an endoscopic sinus debridement and drainage surgery was planned. Figure 3 Generalized yellowish discoloration of all teeth consistent with amelogenesis imperfecta. Intraoral examination revealed dental decay involving the left upper 1st and 2nd molar tooth (distal side of 1st molar and mesial side of 2nd molar) and yellowish discoloration of all the teeth due to the genetic condition called amelogenesis imperfecta(Fig. 3 ). CT scan confirmed dental decay of both upper left 1st and 2nd molars involving pulp and presence of periapical radiolucency apical to the roots of both upper left 1st and 2nd molars suggestive of pus accumulation (Fig. 4 ). Initial vital signs were within normal limits, with no evidence of systemic toxicity. Initial blood workup revealed raised white blood cell count 15.46 3 /mL (normal range- 4.21–10.26) with neutrophilia (91.80%). Her inflammatory markers were also high ESR- 110 mm/H (normal range 00–15). Blood cultures were obtained, and empirical intravenous antibiotics (ceftriaxone and metronidazole) were initiated pending further evaluation. Computed tomography (CT) of the paranasal sinuses demonstrated extensive mucoperiosteal thickening of left maxillary, frontal and ethmoidal sinuses suggestive of sinusitis with collection in left maxillary sinus, consistent with pyosinus ( Fig. 5 ) . There was an evidence of soft tissue collection along the left medial orbital wall suggestive of subperiosteal abscess and irregular shaped rim enhancing collection at the superior aspect of the left orbit extending externally along the left supra-orbital region suggestive of orbital abscess ( Fig. 6 ). Management and outcome The patient was admitted and commenced on broad-spectrum intravenous antibiotics (Ceftriaxone and metronidazole) with close monitoring of clinical response and inflammatory markers. From ophthalmology side, topical antibiotics drops, IOP (intraocular pressure) lowering drops, frequent lubricants and oral acetazolamide was initiated. Preseptal abscess drainage was performed under local anesthesia. The pus culture sensitivity report yielded coagulase negative staphylococcus. From the otorhinolaryngology team, endoscopic nasal debridement and drainage surgery was performed. Intraoperatively, the nasal cavity was found to be inflamed and friable, with involvement of the osteomeatal complex (OMC). Greyish, fungal-like debris was observed in the maxillary sinus, accompanied by frank purulent discharge from the maxillary ostium. A medial maxillary antrostomy was carried out, and the maxillary sinus was irrigated with normal saline solution. This was followed by uncinectomy, anterior ethmoidectomy, removal of posterior ethmoidal cells, and opening of the lamina papyracea to expose the orbital cavity. No pus was noted within the orbit. Tissue specimens were obtained and sent for histopathological examination. Microscopic analysis revealed predominantly necrotic tissue with a few mature bony fragments, surrounded by acute and chronic inflammatory cells—findings consistent with bacterial infection. No fungal elements were identified. The patient demonstrated gradual clinical improvement with resolution of periorbital edema, reduction in proptosis, and restoration of extraocular movements following a 48 hours of antibiotic therapy ( Fig. 7 ). Following the acute management, the patient underwent dental review. The dental team had extracted the tooth with caries, which was the source of the infection, to prevent any further recurrences. Figure 7 Post-treatment clinical photograph showing marked improvement with resolution of periorbital edema, reduction in proptosis and ptosis. Discussion and Conclusions This case highlights the importance of interdisciplinary management of pre-septal and orbital cellulitis secondary to acute rhinosinusitis of odontogenic origin. The close anatomical relationship between the paranasal sinuses, orbit, and oral cavity predisposes individuals to complex infections that require a multidisciplinary approach for optimal diagnosis and treatment. Odontogenic infections are an uncommon but recognized cause of orbital cellulitis, primarily due to the spread of infection through direct bone erosion, perivascular channels, or hematogenous dissemination. The patient’s dental history of untreated caries involving the left upper molars likely acted as the primary focus of infection, progressing to periapical abscess formation and subsequent extension to the maxillary sinus, leading to acute rhinosinusitis and further orbital involvement. Additionally, the abnormal development of the denture-amelogenesis imperfecta- would have contributed to caries formation and associated complications. The CT scan findings of periapical radiolucency, mucoperiosteal thickening of multiple sinuses, and orbital abscess formation were crucial in confirming the diagnosis and guiding management. The differential diagnosis of periorbital swelling includes orbital cellulitis, pre-septal cellulitis, cavernous sinus thrombosis, and idiopathic orbital inflammatory syndrome. The absence of systemic symptoms such as fever or neurological deficits helped in excluding cavernous sinus thrombosis, while the radiological findings differentiated bacterial orbital cellulitis from idiopathic inflammatory conditions. The successful management of this case required collaboration among ophthalmologists, otolaryngologists, and dental specialists. Initial empirical broad-spectrum intravenous antibiotics (ceftriaxone and metronidazole) were crucial in controlling the bacterial infection, particularly given the high risk of intracranial extension. The culture report identifying coagulase-negative staphylococcus guided further antibiotic therapy. Endoscopic sinus surgery performed by the ENT team was essential in debriding the infected sinus cavities and restoring normal drainage, which is critical in preventing recurrence and ensuring resolution. Similarly, from the ophthalmology perspective, intraocular pressure control and supportive ocular management were necessary to prevent vision-threatening complications. The dental team played a pivotal role by identifying the odontogenic source, emphasizing the importance of dental health in preventing sinonasal and orbital complications. Extraction of the culprit denture after controlling the acute infection was the definitive solution, thus preventing any further chances of recurrences. It is also to be noted that amelogenesis imperfecta, can be a predisposing or a risk factor for orbital complications associated to dental problems. The patient showed significant clinical improvement within a few days of treatment initiation, with resolution of proptosis, normalization of intraocular pressure, and restoration of extraocular movements. The decreasing inflammatory markers further indicated a favorable response to treatment. This case underscores several key learning points including the early recognition and diagnosis of odontogenic sources in cases of orbital cellulitis, especially in the presence of a dental history. Imaging studies such as CT scans play a crucial role in delineating the extent of infection, guiding surgical planning, and differentiating between various causes of orbital inflammation. Management of such cases require an interdisciplinary approach with effective collaboration between ophthalmology, ENT, and dental specialists for comprehensive management and favorable outcomes. The timely surgical intervention consisting of prompt surgical debridement of the sinuses and drainage of abscesses are necessary to prevent severe complications such as intracranial spread or vision loss. This case illustrates the importance of interdisciplinary coordination in managing complex infections involving the orbit. Recognizing the potential odontogenic origin of sinusitis and orbital cellulitis can facilitate early intervention, reducing morbidity and preventing complications. Future cases should emphasize the role of preventive dental care in reducing the incidence of such infections Abbreviations ENT- Ear, Nose and Throat IOP- Intraocular pressure OMC- Osteomeatal complex CT- Computed tomography ESR- Erythrosedimentation rate Declarations Ethics approval and consent to participate IRB review was requested, and the institutional review board determined that formal approval was not required for this single-patient case report. Consent for publication Written informed consent was obtained from the patient for publication of their personal and clinical details, along with any identifying images. The patient provided consent voluntarily. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions . Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Authors' contributions T- Concept, design and manuscript preparation. ST- Design and figure preparation. SCT- Design and manuscript editing. PK- Manuscript related to ENT section. TL- Manuscript related to ENT section KSD- Manuscript section related to radiological images interpretation. UP- Manuscript related to dental section. Acknowledgements The authors would like to thank the patient for their willingness to contribute to medical education. References Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414–28. 10.1288/00005537-197009000-00007 . Tsirouki T, Dastiridou AI, Ibánez flores N, Cerpa JC, Moschos MM, Brazitikos P, et al. Orbital cellulitis. Surv Ophthalmol. 2018;63(4):534–53. 10.1016/j.survophthal.2017.12.001 . Gupta S, Goyal R, Gupta RK. Clinical presentation and outcome of the orbital complications due to acute infective rhino sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):431–4. 10.1007/s12070-013-0646-6 . Hegde R, Sundar G. Orbital cellulitis- A review. TNOA J Ophthalmic Sci Res. 2017;55(3):211. 10.4103/tjosr.tjosr_9_18 . Youssef OH, Stefanyszyn MA, Bilyk JR. Odontogenic orbital cellulitis. Ophthalmic Plast Reconstr Surg. 2008;24(1):29–35. 10.1097/IOP.0b013e318160c950 . Stead TG, Retana A, Houck J, Sleigh BC, Ganti L. Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus. 2019;11(7):e5087. 10.7759/cureus.5087 . Constantin F, Niculescu PA, Petre O, Balasa D, Tunas A, Rusu I, Lupascu M, Orodel C. Orbital cellulitis and brain abscess - rare complications of maxillo-spheno-ethmoidal rhinosinusitis. Rom J Ophthalmol. 2017;61(2):133–6. 10.22336/rjo.2017.25 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 01 May, 2026 Reviewers agreed at journal 03 Apr, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 22 Jan, 2026 Editor invited by journal 22 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 17 Jan, 2026 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8628068","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":580460032,"identity":"1b51da64-4f84-4b2f-9cc5-5c385e8ca1ff","order_by":0,"name":"Thinley Thinley","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYDCCAwwMEgwMFglAJuMDIMHDR6QWCZAWZgOQFjZStLBJgAQIauG7ffjgbZ4KiTz+aYePVX7NsZNhY2B++OgGHi2S59KSrXnOSBRL3E5Luy27LRnoMDZj4xw8WgzO8JhJ87ZJJDbczjG7LbmNGaiFh02asJZ/EonzgVqKJbfVE6ulQSJxA1AL48dthwlrkTzDlmw555hE4sbbacnSjNuO87AxE/AL3xnmgzfe1NgkzrudfPDjz23V9vzszQ8f49OCAph5wCSxykGA8QcpqkfBKBgFo2DEAAC1kUUZSz8IBwAAAABJRU5ErkJggg==","orcid":"","institution":"Eastern Regional Referral Hospital","correspondingAuthor":true,"prefix":"","firstName":"Thinley","middleName":"","lastName":"Thinley","suffix":""},{"id":580460038,"identity":"d1001023-78d5-4105-b8fc-123f860b36a8","order_by":1,"name":"Sandip Tamang","email":"","orcid":"","institution":"Eastern Regional Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sandip","middleName":"","lastName":"Tamang","suffix":""},{"id":580460044,"identity":"02e96f1e-eea5-4839-81b3-998980b72a32","order_by":2,"name":"Sonam Choden Tshering","email":"","orcid":"","institution":"Eastern Regional Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sonam","middleName":"Choden","lastName":"Tshering","suffix":""},{"id":580460048,"identity":"cd1ddfb1-2aca-4633-bfa8-3b7623db8ddd","order_by":3,"name":"Tshewang Lhamo","email":"","orcid":"","institution":"Jigme Dorji Wangchuck National Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tshewang","middleName":"","lastName":"Lhamo","suffix":""},{"id":580460052,"identity":"0f264fc9-80c4-4d55-b408-69e40e049b22","order_by":4,"name":"Pushpalal Katel","email":"","orcid":"","institution":"Central Regional Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pushpalal","middleName":"","lastName":"Katel","suffix":""},{"id":580460055,"identity":"472a1272-d5c4-4142-8790-2164ac9c814f","order_by":5,"name":"Kinley Sangay Dorji","email":"","orcid":"","institution":"Jigme Dorji Wangchuck National Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kinley","middleName":"Sangay","lastName":"Dorji","suffix":""},{"id":580460058,"identity":"8f81b339-5983-4a9e-9fad-1f939c23d7fd","order_by":6,"name":"Ugyen Phuntsho","email":"","orcid":"","institution":"Eastern Regional Referral Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ugyen","middleName":"","lastName":"Phuntsho","suffix":""}],"badges":[],"createdAt":"2026-01-17 20:08:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8628068/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8628068/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101296882,"identity":"54f77ced-f479-4a4c-ad92-413673605bd4","added_by":"auto","created_at":"2026-01-28 09:22:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1516441,"visible":true,"origin":"","legend":"\u003cp\u003eClinical photo at presentation showing marked left periorbital swelling and erythema with complete ptosis.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/fa71035222067aa5f0391210.png"},{"id":101297530,"identity":"f9643227-0c57-4783-859d-b50ebd6d0d61","added_by":"auto","created_at":"2026-01-28 09:27:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":801386,"visible":true,"origin":"","legend":"\u003cp\u003eEndoscopic nasal examination showing edematous nasal mucosa with pus discharge from middle meatus. Figure footnotes: \u003cem\u003e\u003cstrong\u003eMT\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e– Middle Turbinate; \u003c/em\u003e\u003cem\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e-Nasal Septum; \u003c/em\u003e\u003cem\u003e\u003cstrong\u003eIT\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e-Inferior Turbinate;\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/9aa7aaad5fd1a2b4f043d44a.png"},{"id":101297059,"identity":"6c36472f-25cc-4038-9ca4-c7a9002c2033","added_by":"auto","created_at":"2026-01-28 09:24:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2032968,"visible":true,"origin":"","legend":"\u003cp\u003eGeneralized yellowish discoloration of all teeth consistent with amelogenesis imperfecta.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/18ab8c4624faf5e2970bdeee.png"},{"id":101397786,"identity":"ada7537c-5b10-44ac-94c8-c184ccc4effb","added_by":"auto","created_at":"2026-01-29 09:37:06","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1380857,"visible":true,"origin":"","legend":"\u003cp\u003eA) Axial view CT image showing the presence of dental caries in upper left 1\u003csup\u003est\u003c/sup\u003e and 2\u003csup\u003end\u003c/sup\u003e molars (blue arrow). B) Coronal view CT image showing dental caries (blue arrow) with upper left 2\u003csup\u003end\u003c/sup\u003e molar with periapical radiolucency (red arrow). C) Sagittal view CT image showing dental caries and periapical radiolucency involving upper left 1\u003csup\u003est\u003c/sup\u003e molar (yellow arrow) and 2\u003csup\u003end\u003c/sup\u003e molar (blue arrow).\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/8b23a383bdd982e62b7f35a2.png"},{"id":101298039,"identity":"338727c9-0f5a-4e45-94de-1c87651d7e57","added_by":"auto","created_at":"2026-01-28 09:29:55","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1465303,"visible":true,"origin":"","legend":"\u003cp\u003eA) Axial, B-C) Coronal and D) Sagittal view of contrast enhanced computed tomography scan of paranasal sinuses showing extensive mucoperiosteal thickening of left maxillary (blue arrow), frontal (orange arrow) and ethmoidal (yellow arrow) sinuses suggestive of sinusitis with collection in left maxillary sinus, consistent with pyosinus.\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/5a759dbb1feafac4d3710a81.png"},{"id":101297874,"identity":"63948d39-b56c-4340-a0eb-aff9aaa62008","added_by":"auto","created_at":"2026-01-28 09:29:09","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1351420,"visible":true,"origin":"","legend":"\u003cp\u003eA) Axial and B) Coronal view of contrast enhanced computed tomography scan of paranasal sinuses and orbit showing a soft tissue collection along the left medial orbital wall suggestive of sub-periosteal abscess (blue arrow) and pre-septal soft tissue collection suggestive of pre-septal cellulitis(yellow arrow) and C) Axial and D) Coronal view showing an irregular shaped rim enhancing collection at the superior aspect of the left orbit extending externally along the left supra-orbital region suggestive of orbital abscess (orange arrow).\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/1a01194a72f9c74692c2ce58.png"},{"id":101297375,"identity":"a1c5a704-5303-4b7c-963a-6d6be23a8378","added_by":"auto","created_at":"2026-01-28 09:26:52","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":752958,"visible":true,"origin":"","legend":"\u003cp\u003ePost-treatment clinical photograph showing marked improvement with resolution of periorbital edema, reduction in proptosis and ptosis.\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/a4422920ff9c1919c29fa5dd.png"},{"id":101398925,"identity":"03b3b384-3db2-482c-83b8-237503a94999","added_by":"auto","created_at":"2026-01-29 09:50:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":9987856,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8628068/v1/e5fc22a2-26c6-4118-b029-44dd7e6cf338.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Orbital Cellulitis as a Complication of Acute Rhinosinusitis of Odontogenic Origin in a patient with Amelogenesis Imperfecta: A Case Report and Literature Review","fulltext":[{"header":"Background","content":"\u003cp\u003eThe anatomical proximity of the orbit to the paranasal sinuses and oral cavity renders it vulnerable to contiguous spread of infections originating in these regions. Orbital cellulitis is a potentially sight- and life-threatening condition characterized by infection of the soft tissues posterior to the orbital septum. It most commonly arises as a complication of acute rhinosinusitis, accounting for up to 75% of cases, particularly in pediatric populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, odontogenic orbital cellulitis\u0026mdash;where the primary source of infection originates from the maxillary teeth or surrounding structures\u0026mdash;is a rare and under-recognized entity [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOdontogenic infections may spread to the orbit through direct bony erosion, perivascular channels, or hematogenous routes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The clinical presentation can be insidious and nonspecific, often mimicking other orbital or sinus pathologies, thereby posing diagnostic and therapeutic challenges. Timely recognition and a multidisciplinary approach are crucial to avoid complications such as vision loss, intracranial extension, and systemic sepsis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe present a rare case of orbital cellulitis and subperiosteal abscess secondary to acute rhinosinusitis of odontogenic origin in a young adult female with amelogenesis imperfecta\u0026mdash;a genetic enamel defect associated with increased risk of dental decay. This case highlights the diagnostic complexities and emphasizes the importance of coordinated management involving ophthalmology, otolaryngology, radiology and dental specialties.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 27-year-old female, with amelogenesis imperfecta, presented to the emergency department with five days\u0026rsquo; history of worsening left periorbital swelling, redness and pain associated with eye movement. With progressive eyelid swelling and protrusion of eyeball the patient started to experience slight diminution of vision accompanied by double vision. The patient reported experiencing toothache preceding the onset of orbital symptoms. She has a history of dental cavities on the ipsilateral side of orbital swelling. Upon further inquiry, she denied fever or any neurological symptoms. Past medical history was unremarkable for immunocompromising conditions or chronic sinus disease.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Clinical photo at presentation showing marked left periorbital swelling and erythema with complete ptosis.\u003c/p\u003e \u003cp\u003eOn examination, the patient appeared acutely ill, with pronounced left periorbital swelling, tenderness, and erythema. Conjunctival injection and chemosis were noted in the affected eye, with associated proptosis and complete ptosis \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Her visual acuity was 6/6 and 6/36 in the right and left eye respectively, with no relative afferent pupillary defect. Intraocular pressure was 20 and 53 mmHg in the right and left eye respectively. Extra ocular movements in the affected eye were limited in all gazes, notably restricted on upward and medial gaze with complaint of pain on eye movement. Posterior segment examination was unremarkable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;2\u003c/b\u003e Endoscopic nasal examination showing edematous nasal mucosa with pus discharge from middle meatus. Figure footnotes: \u003cb\u003eMT\u003c/b\u003e \u003cem\u003e\u0026ndash; Middle Turbinate;\u003c/em\u003e \u003cb\u003eS\u003c/b\u003e\u003cem\u003e-Nasal Septum;\u003c/em\u003e \u003cb\u003eIT\u003c/b\u003e\u003cem\u003e-Inferior Turbinate;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNasal endoscopy performed by ENT (Ear, Nose and Throat) Surgeon showed edematous left middle turbinate with the presence of necrotic tissue along with mucopurulent discharge \u003cb\u003e(Fig.\u0026nbsp;2)\u003c/b\u003e. Examination of right nasal cavity and the neck, ears and oral cavity were unremarkable. Diagnosis of acute rhinosinusitis was made following which an endoscopic sinus debridement and drainage surgery was planned.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e Generalized yellowish discoloration of all teeth consistent with amelogenesis imperfecta.\u003c/p\u003e \u003cp\u003eIntraoral examination revealed dental decay involving the left upper 1st and 2nd molar tooth (distal side of 1st molar and mesial side of 2nd molar) and yellowish discoloration of all the teeth due to the genetic condition called amelogenesis imperfecta(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). CT scan confirmed dental decay of both upper left 1st and 2nd molars involving pulp and presence of periapical radiolucency apical to the roots of both upper left 1st and 2nd molars suggestive of pus accumulation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eInitial vital signs were within normal limits, with no evidence of systemic toxicity. Initial blood workup revealed raised white blood cell count 15.46 \u003csup\u003e3\u003c/sup\u003e/mL (normal range- 4.21\u0026ndash;10.26) with neutrophilia (91.80%). Her inflammatory markers were also high ESR- 110 mm/H (normal range 00\u0026ndash;15). Blood cultures were obtained, and empirical intravenous antibiotics (ceftriaxone and metronidazole) were initiated pending further evaluation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eComputed tomography (CT) of the paranasal sinuses demonstrated extensive mucoperiosteal thickening of left maxillary, frontal and ethmoidal sinuses suggestive of sinusitis with collection in left maxillary sinus, consistent with pyosinus\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. There was an evidence of soft tissue collection along the left medial orbital wall suggestive of subperiosteal abscess and irregular shaped rim enhancing collection at the superior aspect of the left orbit extending externally along the left supra-orbital region suggestive of orbital abscess\u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eManagement and outcome\u003c/h2\u003e \u003cp\u003eThe patient was admitted and commenced on broad-spectrum intravenous antibiotics (Ceftriaxone and metronidazole) with close monitoring of clinical response and inflammatory markers. From ophthalmology side, topical antibiotics drops, IOP (intraocular pressure) lowering drops, frequent lubricants and oral acetazolamide was initiated. Preseptal abscess drainage was performed under local anesthesia. The pus culture sensitivity report yielded coagulase negative staphylococcus.\u003c/p\u003e \u003cp\u003eFrom the otorhinolaryngology team, endoscopic nasal debridement and drainage surgery was performed. Intraoperatively, the nasal cavity was found to be inflamed and friable, with involvement of the osteomeatal complex (OMC). Greyish, fungal-like debris was observed in the maxillary sinus, accompanied by frank purulent discharge from the maxillary ostium.\u003c/p\u003e \u003cp\u003eA medial maxillary antrostomy was carried out, and the maxillary sinus was irrigated with normal saline solution. This was followed by uncinectomy, anterior ethmoidectomy, removal of posterior ethmoidal cells, and opening of the lamina papyracea to expose the orbital cavity. No pus was noted within the orbit.\u003c/p\u003e \u003cp\u003eTissue specimens were obtained and sent for histopathological examination. Microscopic analysis revealed predominantly necrotic tissue with a few mature bony fragments, surrounded by acute and chronic inflammatory cells\u0026mdash;findings consistent with bacterial infection. No fungal elements were identified.\u003c/p\u003e \u003cp\u003eThe patient demonstrated gradual clinical improvement with resolution of periorbital edema, reduction in proptosis, and restoration of extraocular movements following a 48 hours of antibiotic therapy \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Following the acute management, the patient underwent dental review. The dental team had extracted the tooth with caries, which was the source of the infection, to prevent any further recurrences.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e Post-treatment clinical photograph showing marked improvement with resolution of periorbital edema, reduction in proptosis and ptosis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThis case highlights the importance of interdisciplinary management of pre-septal and orbital cellulitis secondary to acute rhinosinusitis of odontogenic origin. The close anatomical relationship between the paranasal sinuses, orbit, and oral cavity predisposes individuals to complex infections that require a multidisciplinary approach for optimal diagnosis and treatment.\u003c/p\u003e \u003cp\u003eOdontogenic infections are an uncommon but recognized cause of orbital cellulitis, primarily due to the spread of infection through direct bone erosion, perivascular channels, or hematogenous dissemination. The patient\u0026rsquo;s dental history of untreated caries involving the left upper molars likely acted as the primary focus of infection, progressing to periapical abscess formation and subsequent extension to the maxillary sinus, leading to acute rhinosinusitis and further orbital involvement. Additionally, the abnormal development of the denture-amelogenesis imperfecta- would have contributed to caries formation and associated complications. The CT scan findings of periapical radiolucency, mucoperiosteal thickening of multiple sinuses, and orbital abscess formation were crucial in confirming the diagnosis and guiding management.\u003c/p\u003e \u003cp\u003eThe differential diagnosis of periorbital swelling includes orbital cellulitis, pre-septal cellulitis, cavernous sinus thrombosis, and idiopathic orbital inflammatory syndrome. The absence of systemic symptoms such as fever or neurological deficits helped in excluding cavernous sinus thrombosis, while the radiological findings differentiated bacterial orbital cellulitis from idiopathic inflammatory conditions.\u003c/p\u003e \u003cp\u003eThe successful management of this case required collaboration among ophthalmologists, otolaryngologists, and dental specialists. Initial empirical broad-spectrum intravenous antibiotics (ceftriaxone and metronidazole) were crucial in controlling the bacterial infection, particularly given the high risk of intracranial extension. The culture report identifying coagulase-negative staphylococcus guided further antibiotic therapy.\u003c/p\u003e \u003cp\u003eEndoscopic sinus surgery performed by the ENT team was essential in debriding the infected sinus cavities and restoring normal drainage, which is critical in preventing recurrence and ensuring resolution. Similarly, from the ophthalmology perspective, intraocular pressure control and supportive ocular management were necessary to prevent vision-threatening complications. The dental team played a pivotal role by identifying the odontogenic source, emphasizing the importance of dental health in preventing sinonasal and orbital complications. Extraction of the culprit denture after controlling the acute infection was the definitive solution, thus preventing any further chances of recurrences. It is also to be noted that amelogenesis imperfecta, can be a predisposing or a risk factor for orbital complications associated to dental problems.\u003c/p\u003e \u003cp\u003eThe patient showed significant clinical improvement within a few days of treatment initiation, with resolution of proptosis, normalization of intraocular pressure, and restoration of extraocular movements. The decreasing inflammatory markers further indicated a favorable response to treatment.\u003c/p\u003e \u003cp\u003eThis case underscores several key learning points including the early recognition and diagnosis of odontogenic sources in cases of orbital cellulitis, especially in the presence of a dental history. Imaging studies such as CT scans play a crucial role in delineating the extent of infection, guiding surgical planning, and differentiating between various causes of orbital inflammation. Management of such cases require an interdisciplinary approach with effective collaboration between ophthalmology, ENT, and dental specialists for comprehensive management and favorable outcomes. The timely surgical intervention consisting of prompt surgical debridement of the sinuses and drainage of abscesses are necessary to prevent severe complications such as intracranial spread or vision loss.\u003c/p\u003e \u003cp\u003eThis case illustrates the importance of interdisciplinary coordination in managing complex infections involving the orbit. Recognizing the potential odontogenic origin of sinusitis and orbital cellulitis can facilitate early intervention, reducing morbidity and preventing complications. Future cases should emphasize the role of preventive dental care in reducing the incidence of such infections\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eENT- Ear, Nose and Throat\u003c/p\u003e\n\u003cp\u003eIOP- Intraocular pressure\u003c/p\u003e\n\u003cp\u003eOMC- Osteomeatal complex\u003c/p\u003e\n\u003cp\u003eCT- Computed tomography\u003c/p\u003e\n\u003cp\u003eESR- Erythrosedimentation rate\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIRB review was requested, and the institutional review board determined that formal approval was not required for this single-patient case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of their personal and clinical details, along with any identifying images. The patient provided consent voluntarily.\u003c/p\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT- Concept, design and manuscript preparation.\u003c/p\u003e\n\u003cp\u003eST- Design and figure preparation.\u003c/p\u003e\n\u003cp\u003eSCT- Design and manuscript editing.\u003c/p\u003e\n\u003cp\u003ePK- Manuscript related to ENT section.\u003c/p\u003e\n\u003cp\u003eTL- Manuscript related to ENT section\u003c/p\u003e\n\u003cp\u003eKSD- Manuscript section related to radiological images interpretation.\u003c/p\u003e\n\u003cp\u003eUP- Manuscript related to dental section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the patient for their willingness to contribute to medical education.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1288/00005537-197009000-00007\u003c/span\u003e\u003cspan address=\"10.1288/00005537-197009000-00007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsirouki T, Dastiridou AI, Ib\u0026aacute;nez flores N, Cerpa JC, Moschos MM, Brazitikos P, et al. Orbital cellulitis. Surv Ophthalmol. 2018;63(4):534\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.survophthal.2017.12.001\u003c/span\u003e\u003cspan address=\"10.1016/j.survophthal.2017.12.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta S, Goyal R, Gupta RK. Clinical presentation and outcome of the orbital complications due to acute infective rhino sinusitis. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):431\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12070-013-0646-6\u003c/span\u003e\u003cspan address=\"10.1007/s12070-013-0646-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHegde R, Sundar G. Orbital cellulitis- A review. TNOA J Ophthalmic Sci Res. 2017;55(3):211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/tjosr.tjosr_9_18\u003c/span\u003e\u003cspan address=\"10.4103/tjosr.tjosr_9_18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoussef OH, Stefanyszyn MA, Bilyk JR. Odontogenic orbital cellulitis. Ophthalmic Plast Reconstr Surg. 2008;24(1):29\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IOP.0b013e318160c950\u003c/span\u003e\u003cspan address=\"10.1097/IOP.0b013e318160c950\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStead TG, Retana A, Houck J, Sleigh BC, Ganti L. Preseptal and Postseptal Orbital Cellulitis of Odontogenic Origin. Cureus. 2019;11(7):e5087. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.5087\u003c/span\u003e\u003cspan address=\"10.7759/cureus.5087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConstantin F, Niculescu PA, Petre O, Balasa D, Tunas A, Rusu I, Lupascu M, Orodel C. Orbital cellulitis and brain abscess - rare complications of maxillo-spheno-ethmoidal rhinosinusitis. Rom J Ophthalmol. 2017;61(2):133\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22336/rjo.2017.25\u003c/span\u003e\u003cspan address=\"10.22336/rjo.2017.25\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Orbital cellulitis, acute rhinosinusitis, odontogenic origin, amelogenesis imperfect, interdisciplinary collaboration","lastPublishedDoi":"10.21203/rs.3.rs-8628068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8628068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOrbital cellulitis is a potentially sight- and life-threatening condition most commonly secondary to acute rhinosinusitis. Odontogenic orbital cellulitis is rare and often under-recognized, with nonspecific presentations that may delay diagnosis. Prompt identification and multidisciplinary management are critical to prevent visual and systemic complications. We present a case of orbital cellulitis as a complication of acute rhinosinusitis of odontogenic origin in a patient with amelogenesis imperfecta.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase presentation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA 27-year-old female with amelogenesis imperfecta presented with progressive left periorbital swelling, pain, and decreased vision over five days\u0026rsquo; duration. She reported suffering from toothache a few days prior to ocular symptoms. Clinical evaluation and imaging revealed pre-septal and orbital cellulitis secondary to acute rhinosinusitis of odontogenic origin, complicated by subperiosteal abscess formation. Immediate surgical intervention included endoscopic sinus debridement and incision and drainage of preseptal abscess followed by the extraction of the culprit tooth. Concurrent use of intravenous antibiotics led to complete resolution of symptoms with preservation of vision.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis case underscores the necessity of early recognition of odontogenic sources of orbital cellulitis and the critical role of coordinated multidisciplinary management. Prompt surgical drainage and targeted therapy can lead to favorable visual and systemic outcomes, even in severe presentations.\u003c/p\u003e","manuscriptTitle":"Orbital Cellulitis as a Complication of Acute Rhinosinusitis of Odontogenic Origin in a patient with Amelogenesis Imperfecta: A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-28 03:05:48","doi":"10.21203/rs.3.rs-8628068/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"141608683933554635890431067900547419656","date":"2026-05-01T11:27:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194300675488569138954180727061831416037","date":"2026-04-03T06:15:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280271023499871910730567207688269356279","date":"2026-02-03T07:05:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T10:56:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-22T05:47:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-21T09:46:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-21T09:45:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-01-17T19:51:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ae8709ce-78e6-4063-be0f-2ebc79db641e","owner":[],"postedDate":"January 28th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"141608683933554635890431067900547419656","date":"2026-05-01T11:27:28+00:00","index":47,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-28T03:05:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-28 03:05:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8628068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8628068","identity":"rs-8628068","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}