Parietal Subdural Empyema as Complication of Acute Odontogenic Sinusitis: A Case Report

Francesco Martines; Pietro Salvago; Sergio Ferrara; Marianna Mucia; Angelo Gambino; Federico Sireci


J Med Case Reports. 2014;8(282) 

In This Article

Abstract and Introduction


Introduction: To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity.

Case presentation: An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms.

Conclusions: The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment.


Suppurative intracranial infections (meningitis, intracranial abscess, subdural empyema and epidural abscess) are uncommon sequelae of paranasal sinusitis. In fact, the incidence of morbidity and mortality has been reported to range from 5 to 40%;[1–4] this is because the diagnosis is often unsuspected.[5]

The literature on intracranial complications of sinusitis consists mainly of case reports with the exception of a few large series of hospitalized patients that present a rate of intracranial complications that varies from 3.7% to 47.6%.[2,6,7]

However, paranasal sinuses disease is the presumed underlying cause of approximately 10% of intracranial suppuration.[3,7]

The frontal lobe is the most common location, and it is usually caused by chronic frontal sinusitis associated to nasal polyposis. Parietal lobe abscesses are usually associated with sphenoid rhinosinusitis, whereas there is rarely a correspondence to a temporal lobe abscess.

To date there is no evidence of an intracranial complication caused by tooth extraction. In fact, based on clinical presentation and microbiology, odontogenic paranasal sinus infections usually can be differentiated from those attributed to upper respiratory tract infections;[8] odontogenic paranasal sinus infections cause swelling in one or more of the deep fascial spaces of head and neck.

We report a rare and insidious case of parietal subdural empyema evolving over 2 weeks, secondary to dental extraction.