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Oral Radiology Oral Surgery

oasisImage of the Week: Why can’t he feel his forehead?

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A 35-year old man develops a serious infection from an impacted 2.8.

The tooth is extracted and the infection is drained but he develops a serious bleed 3 days after surgery (from the internal maxillary artery) which requires neuroradiology embolization.

One month later, he has recurrent swelling around the left temple and TMJ but also complains he feels numbness in the entire trigeminal nerve, including V-1. Attached is a slice of the MRI and an intraoperative shot.

Why can’t he feel his forehead?

Why can't he feel his forehead?

Why can’t he feel his forehead?

To treat the root cause of his numb forehead

To treat the root cause of his numb forehead

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3 Comments

  1. Brian Clark January 31, 2013

    Clearly there is pressure on the trigeminal nerve somewhere but where? With such a massive infection originally, where has the infection spread? Why was the infection so massive?

    Reply
    1. when he bleed and we embolized the I-Max artery, the condylar head necrosed and became a massive nidus for infection. It spread into the infratemporal fossa and got thru the skull base via either the f. ovale or rotundum (?long forgotten anatomy!!!).

  2. Jonathan Visscher February 12, 2013

    I have seen these symptoms on a woman in Myanmar. We removed all the decayed teeth on the right side of her face to allow for healing, but were only there for a couple days so no follow-up. She had no clue that decayed teeth were not normal, or that they were contributing to her symptoms/pain/swelling/numbness and inability to smile, etc.

    Reply

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