BY: SARAH JOYCE R.

PADILLA

A cavernous sinus thrombosis is a blood clot within the cavernous sinus, a large channel of venous blood in a cavity bordered by the sphenoid bone and the temporal bone of the skull. A thrombosis (clot) in this key crossroads causes the cavernous sinus syndrome which is characterized by edema (swelling) of the eyelids and the conjunctivae of the eyes and paralysis of the cranial nerves which course through the cavernous sinus.

Oblique section through the cavernous sinus

Symptoms

Causative agent

Bulging eyeballs Cannot move the eye in a particular direction Drooping eyelids Headaches Vision loss

Staphylococcus aureus and Streptococcus are

often the associated bacteria

Recognizing the primary source of infection (i.e., facial cellulitis, middle ear, and sinus infections) and treating the primary source expeditiously is the best way to prevent cavernous sinus thrombosis.

Broad-spectrum intravenous antibiotics are used until a definite pathogen is found. Nafcillin 1.5 g IV q4h Cefotaxime 1.5 to 2 g IV q4h Metronidazole 15 mg/kg load followed by 7.5 mg/kg IV q6h

Vancomycin may be substituted for nafcillin if significant concern exists for infection by methicillin-resistant Staphylococcus aureus or resistant Streptococcus pneumoniae. Appropriate therapy should take into account the primary source of infection as well as possible associated complications such as brain abscess, meningitis, or subdural empyema. Anticoagulation with heparin is controversial. Retrospective studies show conflicting data. This decision should be made with subspecialty consultation. Steroid therapy is also controversial and is not recommended by many sources.

Surgical drainage with sphenoidotomy is indicated if the primary site of infection is thought to be the sphenoidal sinuses. All patients with CST are usually treated with prolonged courses (34 weeks) of IV antibiotics. If there is evidence of complications such as intracranial suppuration, 68 weeks of total therapy may be warranted. All patients should be monitored for signs of complicated infection, continued sepsis, or septic emboli while antibiotic therapy is being administered.

Otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Friedrich von Ludwig who first described this condition in 1836. Other names include "angina Maligna" and "Morbus Strangularis".

Ludwig's angina should not be confused with angina pectoris, which is also otherwise commonly known as "angina". The word "angina" comes from the Greek word ankhon, meaning "strangling", so in this case, Ludwig's angina refers to the feeling of strangling, not the feeling of chest pain, though there may be chest pain in Ludwig's angina if the infection spreads into the retrosternal space.

Symptoms include

Other symptoms that may occur with this disease

Breathing difficulty Confusion or other mental changes Fever Neck pain Neck swelling Redness of the neck Weakness, fatigue, excess tiredness

Difficulty swallowing Drooling Earache Speech that is unusual and sounds like the person has a "hot potato" in the mouth

Treatment involves appropriate antibiotic medications, monitoring and protection of the airway in severe cases, and, where appropriate, urgent maxillo-facial surgery and/or dental consultation to incise and drain the collections. A nasotracheal tube is sometimes warranted for ventilation if the tissues of the mouth make insertion of an oral airway difficult or impossible. In cases where the patency of the airway is compromised, skilled airway management is mandatory. This entails management of the airway according to the American Society of Anesthesiologists' "Difficult Airway Algorithm" and necessitates fiberoptic intubation

The cause is usually an infection with Streptococcal bacteria, although other bacteria can cause the condition. Since the advent of antibiotics, Ludwig's angina has become a rare disease.

A tonic contraction of the muscles of mastication. In the past, this word was often used to describe the effects of tetanus, also called 'lock-jaw'. More recently, the term 'trismus' has been used to describe any restriction to mouth opening, including restrictions caused by trauma, surgery or radiation. This limitation in the ability to open the mouth can have serious health implications, including reduced nutrition due to impaired mastication, difficulty in speaking, and compromised oral hygiene. In persons who have received radiation to the head and neck, the condition is often observed in conjunction with difficulty in swallowing.

The most obvious effect of trismus is difficulty in opening the mouth. In cancer patients this frequently results from scar tissue from radiation or surgery, nerve damage, or a combination of factors. In stroke patients, the general cause is central nervous system dysfunction. Difficulty in speech and swallowing often accompany the limitation in mouth opening, and create a combination of symptoms that may be difficult to treat. In cases of trismus caused by radiation treatment, patients also frequently present with Xerostomia, mucusitis, and pain as a result of radiation burns. There may also be associated symptoms such as headache, jaw pain, ear ache, deafness, or pain on moving the jaw. In cases of Temporomandibular tightness, the joint itself may become fibrotic, or even (in rare cases) ankylotic. Each of these factors may affect the treatment provided to the patient.

Pericoronitis Inflammation of muscles of mastication Peritonsillar abscess Temporomandibular joint disorder (TMD) temporary side effect of many stimulants of the sympathetic nervous system like bruxism as a sideeffect Submucousfibrosis.

Acute osteomyelitis Ankylosis of the TMJ (fibrous or bony) Condylar fracture or other trauma. Gaucher disease which is caused by deficiency of the enzyme glucocerebrosidase. Giant cell arteritis Infection Local anesthesia Needle prick to the medial pterygoid muscle Oral submucous fibrosis. Radiation therapy to the head and neck. Tetanus Malignant hyperthermia Malaria severa Secondary to neuroleptic drug use Malignant otitis externa Retropharyngeal or parapharyngeal abscess

Treatment requires treating the underlying condition with dental treatments, physical therapy, and passive range of motion devices. Additionally, control of symptoms with pain medications (NSAIDs), muscle relaxants, and warm compresses may be used. Splints have been used