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from the tooth bud: (i) to erupt on the alveolar margin; (ii) to involve the
neighbouring infantile maxillary sinus so that pus escapes into the nasal
cavity and appears at the anterior naris; and (iii) into the orbit to produce an
orbital cellulitis (Fig. 38) which may be severe and give rise to sequestrum
formation at the outer canthus.

Pus from the nose and alveolar margin is cultured and from the sensitivity
tests a course of the appropriate antibiotic is given. Until these results are

Fig. 38. Osteomyelitis of the maxilla in an
infant, showing oedema of the eyelids and
nasal discharge.

obtained a broad-spectrum antibiotic such as ampicillin with cloxacillin
(Ampiclox) is used. If the correct antibiotic is given for at least 7 days, and
preferably 10 days, a complete recovery is to be expected. There is no need to
drain the maxillary sinus. When the first upper molar tooth erupts it is
discoloured and lacks enamel.


Infection may spread from the sinuses to involve the brain or the meninges,
either by a spreading thrombophlebitis or by direct extension if there has been
a fracture or surgical trauma. Infection may spread from the nasal cavity
along the perineural sheaths of the olfactory nerves. Intracranial complica-
tions have become less common since the routine treatment of sinus infections
by antibiotics.

Meningitis may arise from acute or chronic infection in the ethmoidal or
frontal sinuses by a spreading thrombophlebitis, from a spread along the
perineural sheaths of the olfactory nerves following infection in the nasal
cavity, or rarely from surgical puncture of an encephalocele. The clinical
features are those of meningitis from any other cause, and treatment is
antibiotic, preferably the appropriate one if this can be discovered.

Brain abscess most commonly arises from frontal sinusitis in which the
infection erodes the posterior wall of the sinus to produce an extradural
abscess or an abscess of the frontal lobe. The frontal lobe does not give rise to