Dangerous Area of Face

Dangerous area of face: pushed up through the valve less veins by movements of the facial muscles to the Dangerous area of face comprises of upper lip, cavernous sinus. lower part of nose and adjacent area. This area has The adequate management of facial been so named because boils, infections of the nose furuncle to prevent spread of infection to and injuries around the nose, especially those that cavernous sinus is of paramount become infected can readily spread to cavernous importance. Staphylococcal infection of a sinus resulting in cavernous sinus thrombosis hair follicle is the usual cause. A furuncle is (CST). CST is generally a fulminant process with a deep seated, firm, tender nodule that high rates of morbidity and mortality. Fortunately, enlarges, becomes erythematous, painful the incidence of CST has been decreased greatly and fluctuant after several days. This with the advent of effective antimicrobial agents. localized infection, may develop into an abscess. The treatment comprises moist heat Anatomical Considerations: initially; most strains of staphylococci are sensitive to clindamycin and doxycycline. Anterior facial vein begins at the side of root of Surgical incision and drainage is required nose through the union of supra-orbital and frontal when fluctuation is palpable. Systemic veins. The vein drains upper lip, septum of nose treatment with antibiotics is indicated for and adjacent areas. The anterior facial vein systemic symptoms or extensive cellulites. communicates with the cavernous sinus through CST is characterized by severe headaches, the ophthalmic veins. It also communicates with neck stiffness, altered consciousness levels cavernous sinus via deep facial vein which and epileptic fits. Clinically there is high connects the pterygoid plexus with anterior facial grade fever, rigors, headaches, a reduced vein. conscious level, and signs of cerebral irritation. An ophthalmoplegia results from Key points: paralysis of cranial nerves that travel within CS viz III, IV and VI and ophthalmic and Anterior facial vein has no valves and it maxillary nerves. The eyes are proptosed makes possible bidirectional blood flow in with considerable swelling in the area. the vein. The mainstay of therapy is early and It lies amongst muscles which by aggressive antibiotic administration. contraction may displace the clot in the Although S aureus is the usual cause, vein. broad-spectrum coverage for gram-positive, This area (dangerous area of face) is lacking gram-negative, and anaerobic organisms in deep fascia, which acts as barrier to the should be instituted pending the outcome spread of inflammation and the infective of cultures. IV antibiotics are recommended processes have ready access to muscles. for a minimum of 3-4 weeks. The highly anastomotic and valve less Corticosteroids may help to reduce venous system allows retrograde spread of inflammation and edema and should be infection to the cavernous sinus via the considered as an adjunctive therapy. They superior and inferior ophthalmic veins. should be instituted after antibiotic Any forceful squeezing, manipulation of coverage. When the course of CST leads to furuncle, infection or abscesses in this area pituitary insufficiency, however, may push up the infection towards the corticosteroids definitely are indicated to cavernous sinus. prevent adrenal crisis. Dexamethasone or Nasal septal abscesses that may follow hydrocortisone should be considered. trauma or surgery should be carefully Surgery on the cavernous sinus is incised avoiding any injury to the adjoining technically difficult and has never been healthy area. If the healthy tissue is incised shown to be helpful. The primary source of in the neighborhood of infection, the infection should be drained, if feasible (eg, infection may reach the veins and result in sphenoid sinusitis, facial abscess). clot formation. This clot in turn may be .

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