Anatomy & Histology · patient case question
Spread to which structure is the greatest concern?
Patient case: Spreading swelling of the upper face
Patient: 37-year-old man, emergency appointment.
Chief complaint: My face is swelling and it is getting worse quickly.
History: Two days of increasing swelling that began around an upper tooth. Now feels feverish and unwell.
Findings: Diffuse, firm, warm, erythematous swelling of the right upper face extending toward the medial canthus and lower eyelid. No fluctuance. Temperature 38.6°C. Grossly carious maxillary tooth with periapical tenderness.
Show answer and explanation
Correct answer: C. Cavernous sinus
- A. The submental space lies beneath the chin and drains mandibular anterior teeth.
- B. The pterygomandibular space is entered from mandibular molars and is the target of an inferior alveolar nerve block.
- C. CORRECT. The upper lip, nose and medial canthus form the DANGER TRIANGLE. Venous drainage here is VALVELESS, so infection can travel retrograde through the angular and ophthalmic veins to the CAVERNOUS SINUS, producing cavernous sinus thrombosis — ophthalmoplegia, proptosis, chemosis and a life-threatening intracranial infection.
- D. The retropharyngeal space is involved in deep neck infections spreading posteriorly, not from the upper face.
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