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14 I I case report _ cavernous sinus infection _Once upon a time, a patient walked into my of- fice without an appointment. She introduced herself and said that her otorhinolaryngologist had referred hertomyoffice.IaskedmyassistanttotaketheX-rays, conduct computed tomography (CT) scanning and schedule the patient as soon as possible. During cof- feebreak,Iwasgoingthroughthescansanddecidedto lookatnotonlytheprintoutsbutalloftheslidesburnt on the CD. As I was browsing through the slides, I re- alised that the palatal and mesial roots were piercing the sinus membrane and there was infection around them (Fig. 1). I went a few millimetres up and saw an openinginthemiddleofthesinus(Fig.2).TodayIknow that it would have been a fatal error on my part had I stopped at this level. I do not know what made me continue my observation, but fortunately I did. A few millimetres higher, the infection was occu- pying the greater part of the maxillary sinus and perforating the sinus (Fig. 3). Even further up, the infectionwasinvadingtheorbit(Fig.4).Thereallyun- pleasant surprise was a thickening of the cavernous sinus observed in two slides (Fig. 5), and cold sweat covered my face. At this point, any flare-up, inflam- mation or infection could lead to such severe conse- quencesasthrombosisinthecavernoussinus,bring- ing about a true life-or-death drama for the patient. Beforepresentingtherestoftheclinicalcase,here is a brief summary of the sinuses. _Sinus definition—physiology Sinusesareair-filledcavitieswithclassical,pseudo- stratified, ciliated columnar epithelium interspersed with goblet cells. The cilia sweep mucus towards the ostial opening. Obstruction of sinus ostia might lead to mucous impaction and decreased oxygenation in thesinuscavities.Duringobstructionoftheostia,the pressure in the sinus cavity may decrease, which in turn causes the symptom of pain, particularly in the frontal region. Fig. 1_Palatal and mesial roots pierced the sinus membrane. Fig. 2_The opening in the middle of the sinus could lead to misdiagnosis. Fig. 3_The infection occupied the greater part of the maxillary sinus and perforated the sinus. Fig. 4_The infection invaded the orbit. Fig. 5_Thickening of the cavernous sinus. roots4_2010 Acavernous sinus infection: Aroot-canal case Author_ Dr Philippe Sleiman, Lebanon Fig. 3 Fig. 4 Fig. 5 Fig. 1 Fig. 2