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ROEN0410

I 17 case report _ cavernous sinus infection I roots4_2010 fectedthrombusmayextendintothecavernoussinus producing thrombophlebitis of the cavernous sinus. The infection usually involves only one sinus initially butmayspreadtotheoppositesidethroughtheinter- cavernous sinuses. Thrombophlebitis of the cavernous sinus may affect the abducent nerve as it traverses the sinus and may also affect the nerves embedded within the lateral wall of the sinus. Septic thrombosis of the cavernous sinus often results in the development of acutemeningitisandsometimesthelifeofthepatient may be endangered. _Case report Afterexaminingthepatient,Icalledherotorhino- laryngologistandaneurologisttomeetintheevening to discuss the case and we decided to put the patient on antibiotic therapy for three days prior to the be- ginning of the treatment. In the meantime, a conser- vative treatment was outlined, including root-canal treatment and tooth restoration. Three days later, the patient returned to my office where I opened the tooth under strictest infection- control conditions. The canals were enlarged using Twisted Files (SybronEndo) to the size of 40, taper 0.04 in the apical part. No swelling was observed and obturation was done in the same session using Real- Seal (SybronEndo), followed by composite coronal restoration placed immediately in order to stop any possible coronal leakage (Fig. 6). The patient was checked regularly and an i-CAT was performed. I was very pleased to see the positive results and the healing of the greater part of the infection (Figs. 7 & 8). Most importantly, a complete healing of the cavernous sinus was observed (Fig. 9). At the 18-month check-up, we saw the healing of the sinus above the molar. _Conclusion A fatal error may have been made had I decided to extract the tooth. Under these circumstances, we wouldhavepotentiallycausedaflare-up,whichcould have resulted in severe consequences. It is important tounderlinethatweshouldtrustourroot-canaltreat- ment and use strict measures in bacteria and micro- organism control, starting from access cavity opening to the root-canal shaping, especially in the last 3mm, where a size 40.04 Twisted File was used for apical enlargement. Obturation was done with RealSeal. This highly bio-compatible material is zinc and eugenol free, making aspergillosis and sinus inflammation due topasteextrusionbeyondapexhighlyunlikely.Thefinal resultsdemonstrateacompletehealingofthesinuses, ofwhichthepatientwasveryrelievedtolearn(Fig.10). The main message of this article is that we need to take our time in determining the correct diagnosis for each case that is presented to our office. We have to go beyond the oral sphere. The proper approach can ensure excellent results in a simple and straight- forward treatment. I would like to thank Phd Yulia Vorobyeva, inter- preter and translator, for her help with this article._ Editorial note: A list of references is available from the publisher. Figs. 9 & 10_Healing of the sinuses. Dr Philippe Sleiman Dubai Sky Clinic Burjuman BusinessTower,Level 21 Trade Center Street,Bur Dubai Dubai,UAE phil2sleiman@hotmail.com _contact roots Fig. 9 Fig. 10