CUENTO, Meryl Grace R.

PGI - ENT
Dr. Jimena-Baligod

DANGER TRIANGLE OF THE FACE

Case: Pustule, Left Nostril, Anterior Epistaxis - Resolved, Allergic Rhinitis

Anatomy (Facial Vein):

● Facial vein begins at the side of the root of the nose through the union of
supraorbital and frontal veins.
● Drains upper lip, septum of nose, and adjacent areas
● The facial vein makes connections with the cavernous sinus through the superior
ophthalmic vein, and the pterygoid venous plexus through the inferior ophthalmic and
deep facial veins

Danger Triangle of the Face:

● From the upper lip, lower part of nose to the bridge of the
nose
● Named because boils, infections of the nose and injuries
around the nose, especially those that become infected can
readily spread to cavernous sinus resulting in cavernous
sinus thrombosis (CST)
○ Infection of the facial veins spreading to the dural
venous sinuses may result from lacerations of the
nose or be initiated by squeezing pustules
(pimples) on the side of the nose and upper lip
● Facial veins has no valves, blood may pass through in the opposite direction
(bidirectional blood flow) → Venous blood from the face may enter the cavernous
sinus
● This area lacks deep fascia which acts as a barrier against spread of inflammation

Thrombophlebitis of Facial Vein and Cavernous Sinus

● Inflammation of the facial vein with secondary to thrombus formation → pieces of an
infected clot may extend into the intracranial venous system → Thrombophlebitis of
the cavernous sinus
○ Cavernous sinus thrombosis usually results from infections in the orbit, nasal
sinuses and superior part of the face
■ Any forceful squeezing, manipulation of furuncle, infection or abscess
may push up the infection towards the cavernous sinus
○ Characterised by severe headaches, neck stiffness, altered consciousness
levels and epileptic fits
○ Mainstay of therapy: Early and aggressive antibiotic administration

Reference/s:
Moore, K. L., Agur, A. M. R., Dalley, A. F., II., & Moore, K. L. (2015). Essential clinical
anatomy. Fifth edition.