PMC5010441_01
Emergency department computed tomography, showing marked left facial edema with slight proptosis caused by the periorbital cellulitis.
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F1
Immediately after the injection, the patient experienced a sudden, sharp intense pain in the left maxillary region, associated with a rapidly developing swelling and anesthesia-paraesthesia of the left hemiface, and ipsilateral periorbital cellulitis (Fig. 1).
Emergency department computed tomography, showing a thickened inflamed mucosa in the left maxillary sinus floor in the vicinity of the protruding tooth roots, with total opacification of the homolateral anterior ethmoid sinus and of the remaining nasal cavity. Evidence of destruction of the antral bony walls, including of the orbital floor, is seen. Periorbital cellulitis with densification of the intraorbital fat and thickening of the inferior rectus muscle and medial rectus muscle is shown.
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F2
At the emergency department of a large tertiary care hospital, she was diagnosed with acute, "chemically induced," maxillary inflammatory disease; computed tomography of the sinus showed a thickened mucosa in the left antrum floor, which occurred simultaneously with severe inflammation of the homolateral ethmoid sinus in the areas that correspond to the drainage pathway of the maxillary sinus (Fig. 2). Periorbital cellulitis was also present, with densification of the intraorbital fat and thickening of the inferior rectus muscle and the medial rectus muscle (Fig. 2).
Endoscopic evidence, during surgery, of the intense acute inflammation of the antral mucosa. *The dehiscent infraorbital nerve on the orbital floor.
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F3
Clear signs were then seen that the antral mucosa was experiencing an intense inflammatory process, "like a massive chemical burn," with various areas of destruction of its bony walls, including a dehiscence of the infraorbital nerve on the orbit floor (Fig. 3).