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Epidural Spinal Abscess after Extraction of a Tooth - a Rare but Possibly Fatal Complication

School of Dental Medicine, University of Zagreb, Croatian Dental Society - Croatian Medical Association
Publication Date
  • Biology
  • Medicine


The complications of an odontogenic abscess are well known, and difficulty swallowing in the case of a submandibular or pterygomandibular abscess is a serious and a valuable sign. However, the majority of physicians are unaware that a stiff and painful neck can indicate complications of odontogenic infection. In fact it is one of the first, and at the same time the main symptom in epidural spinal abscess. Only a few cases have been presented in the literature of patients treated with such an abscess. The specificity of an epidural spinal abscess is that it occurs in a very small number of patients (0.2 to 1.2 in 10000 patients), abruptly or a few days or a week after infection, anywhere in the body and most often in immunocompromised patients. The main symptoms are: 1. Pain in the spine within 24 hours, which increases within three days of the operation. 2. Stiffness gradually increases. 3. Reduced control of the bladder and intestines. 4. Rapid progression toward paralysis. As stiffness of the neck is the earliest sign of epidural spinal abscess it should not be treated lightly, because of the possibility of a lethal cause of such an abscess, particularly when a patient arrives with signs of acute torticolis, after a recent operation in connection with the teeth and oral cavity. We contemplated such pathology in two patients admitted to the Clinic of Maxillofacial and Oral Surgery, University Hospital Dubrava, and retained for treatment and observation.

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