The spread of odontogenic infections to the orbit: diagnosis and management.

Four cases of orbital cellulitis following the extraction of maxillary molars are presented. The time interval between dental extraction and development of orbital symptoms ranged from two hours to 13 days. All patients presented with fever, elevated leukocyte counts, and radiologic evidence of acute ipsilateral paranasal sinus infection. In addition, one patient presented with meningitis. Predisposing factors in three patients included nephrotic syndrome with chronic antral inflammation, pregnancy with upper respiratory tract infection, and heroin addiction. Sequelae included empyema and death, severe loss of vision, and blindness with ptosis and exotropia. One patient recovered completely. The anatomic pathways by which dental infection can spread to the orbit are discussed, and general therapeutic considerations are emphasized.