Odontogene Thrombophlebitis des Sinus cavernosus durch MRSA - Fallbericht und Literaturüberblick

Objective: Presentation of etiology, clinical signs and therapy of the odontogenic thrombophlebitis of the cavernous sinus by MRSA ( Methicillin resistant Staphylococcus aureus ) in form of a case report and review of the literature. Material and Methods: A 63 year old, male patient contacted the emergency room with reduced general condition and the following main clinical symptoms : fever more than 39,5 °C , massive headache, nausea, vomiting, meningism, exophthalmos and chemosis of the right eye and abducens paralysis at the right. Anamnestic the patient reported operative extraction of wisdom tooth 18. The following diagnostic procedures were performed : clinical neurological, medical and maxillofacial diagnostic assessment, CT, MRT, dental radiology ( OPG, dental x-rays ), diagnostic serology, lumbar punction and CSF examination including microbiology / polymerase chain reaction, and intraoral smear. Review of the literature was made in databases PubMed / Medline and Embase. Results: Diagnostic views confirmed the diagnosis "septic thrombophlebitis of the right cavernous sinus". Initially high-dose wide-spectrum antibiotics, anticoagulation and intensive care treatment was required. Microbiology and CSF examination showed intraoral and intracranial the same variety of MRSA, without findings of other relevant bacterias or viruses. After diagnosis by exclusion, as only potential cause the tooth extraction remained. After sensivity testing, changing of antibiotics, anticoagulation and conservative therapy without invasive treatment lead to a quick regression of clinical and serological signs with a complete restitutio ad integrum. In total we found only 18 relevant publications concerning odontogenous thrombophlebitis of the cavernous sinus. Non of them reported clearly ascending intracranial infection with MRSA after dental oral surgery as etiology. Conclusions: Odontogenous intracranial infections are rare and need quick adequate interdisciplinary diagnostics and therapy. Multiresistant and nosocomial buds show raising incidence and gain more and more clinical relevance. Special treatment is required in such cases. Keywords: Sinus cavernosus, Thrombophlebitis, odontogen, MRSA