Relationship between cavernous sinus thrombosis and odontogenic infections. Systematic review

Abstract

Cavernous sinus thrombosis (CST) is a rare but severe neurological condition that progresses rapidly and has a high mortality rate if not diagnosed and treated promptly. It is characterized by the formation of a thrombus (blood clot) in the cavernous sinus, an intracranial venous structure that houses important cranial nerves and the internal carotid artery. This study is based on a literature review of scientific articles focusing on the etiology, clinical manifestations, diagnosis, and treatment of CST. The most common symptoms include severe headache, fever, ophthalmoplegia, periorbital edema, decreased visual acuity, cranial nerve impairment signs, and especially facial or sinus infections. Magnetic resonance imaging with venography is the diagnostic method of choice, and early initiation of broad-spectrum empirical antibiotic therapy combined with anticoagulation significantly improves prognosis. The findings highlight that up to 30% of CST cases have an infectious origin, with sinusitis, dental infections, and orbital cellulitis being the most frequent causes. These can stem from deep infections such as periapical abscesses, upper third molar infections, facial cellulitis, or complicated dental procedures—especially when venous structures directly connected to the cranium are involved. Therefore, the importance of early diagnosis in patients with a history of facial infections and a prompt, multidisciplinary therapeutic approach is emphasized.