Dural Venous Sinus Thrombosis due to maxillary sinus infection

Dural venous sinus thrombosis ( DVST ) is a sporadic disease with an unreliable prognosis. Diverse aetiologies play major role in the development of dural sinus thrombosis like infections from paranasal sinusitis, intracranial abscess, otitis, mastoiditis and meningitis have also been reported. DVST is a rare complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet.

The trabeculated cavernous sinus acts as sieves, fltering bacteria, thrombi from the maxillary sinus, medial third of face and teeth. Due to lack of one-way valves infected thrombi or blood clot from deep facial vein or inferior ophthalmic vein communicate to cavernous sinus via pterygoid plexus.

Clinical presentations are various in DVST and headache is themost common presenting symptom. Sensory defcits, dysphagia, seizures occurs in 75% of cases. Magnetic Resonance Imaging (MRI) combined with Magnetic Resonance Venography (MRV) remains gold standard imaging technique in diagnosing DVST.

The corner stone of DVST treatment is administration of anticoagulants such as low molecular weight heparin and warfarin. Dentist often accidently diagnose maxillary sinusitis during routine radiographic examination like intraoral periapical radiograph and panoramic tomogram.

Most of maxillary sinusitis patient present with pain originating from orofacial region. Severe headache, papilloedema with signs like kernig’s sign tends to preponderate in most cases of DVST. Early aggressive treatment of infection involving maxillary sinus can prevent the development of DVST