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  1. Mark January 31, 2013

    My guess, cavernous sinus infection.

    Forehead sensation is supplied by V1 – Opthalmic. Trigeminal ganglion makes up the lateral border of the cavernous sinus so I’m assuming that pressure within that space would cause paresthesia of the 3 branches of the trigeminal nerve.

    From your treatment picture it looks as though you dissected as close to the area as possible (pterygomaxillary fissure) and placed a shunt to allow drainage and oxygenation of the tissues.

    I’m not entirely sure on the pathway of infection into the cavernous sinus but I would assume the bacteria would go from the pterygomaxillary fissure into the inferior / superior orbital fissure to gain access??

    Anyways, not sure how accurate that is, but that is my guess.


    1. Awesome guess Mark, when he had the I-max bleed, it was embolized and the condylar head necrosed causing a massive infratemporal fossa infection. There was cavernous sinus involvment (thankfully, not thrombosus) causing the paraesethesia. It likely transitted the skull base through the f. rotundum or ovale. Nice diagnosis, that was a tough one.

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