Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

Journal of Oral and Maxillofacial Surgery, Medicine, and

Pathology
journal homepage: www.elsevier.com/locate/jomsmp

Case Report

Intracranial extension of Lemierre’s syndrome from odontogenic cause: A

review and case report
Hongyi Adrian Shia,*, Chung Wen Raymond Wongb
a
Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore
b
Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, National University Health System Singapore

A R T I C LE I N FO A B S T R A C T

Keywords: Odontogenic infection is one of the most common conditions treated by Oral and Maxillofacial surgeons.
Odontogenic infection Complications from odontogenic infection such as Ludwig’s angina, descending mediastinitis, and neurological
Complications spread of infection have been well reported in the literature. A rare and lesser-known but potentially life-
Sinus thrombosis threatening complication of odontogenic infection is Lemierre’s syndrome which is characterised by throm-
Lemierre’s syndrome
bophlebitis of the internal jugular vein. This article provides a literature review and reports a case with in-
tracranial extension of Lemierre’s syndrome from an odontogenic cause. This case report illustrates how prompt
diagnosis, with appropriate medical and surgical management, resulted in a positive treatment outcome without
the need for anticoagulation therapy. The importance of this life-threatening syndrome cannot be overlooked by
Oral and Maxillofacial surgeons.

1. Introduction thrombosis of the left sigmoid and transverse sinuses.

Odontogenic infection is one of the most common conditions treated
by oral and maxillofacial surgeons. The severity of odontogenic infec-
tions can range from very mild in the early stages to fairly severe if left
untreated and can be fatal. Early recognition of the infection, prompt
diagnosis of the infection source with clinical and radiological in-
vestigations, medical treatment with appropriate antimicrobial therapy
and aggressive surgical treatment can reduce the morbidity and mor-
tality rates of such cases. Serious complications such as Ludwig’s an-
gina, descending mediastinitis and neurological spread of infection
have been well reported in the literature [1]. A lesser-known and rare
complication of odontogenic infection is Lemierre’s syndrome [2].
Lemierre’s syndrome, initially termed anaerobic post-anginal sep-
ticaemia, was first described in 1936 by Andre Lemierre, a French
physician [3]. This syndrome is characterised by an initial infection
which quickly progresses to cause thrombophlebitis of the internal ju-
gular vein. Further complications which can occur are metastatic in-
fections and septicaemia. If left untreated, Lemierre’s syndrome had a
high mortality rate of approximately 80–90 % in the pre-antibiotic era.
Odontogenic infection is an uncommon cause of Lemierre’s syndrome
and can potentially be overlooked during the diagnostic process [4,5].
This article provides a literature review and reports a case of
Lemierre’s syndrome from an odontogenic cause which resulted in
2. Case report
A 28-year-old female with no significant medical history presented
with fever and left facial swelling of 5 days duration (Fig. 1). She also
complained of a toothache from the left mandibular molar region. On
presentation, she was febrile (38.8 °C), but her other vital signs were
within normal limits. She had a blood pressure of 126/76mmhg, heart
rate of 82 beats/min, respiratory rate of 18 breaths/min and her mental
status was not altered. She also presented with trismus of 2 mm mouth
opening and was progressively having difficulty swallowing but was not
dyspnoeic. She had cervical lymphadenopathy at left neck levels 1B and
IIA but did not have neck tenderness or restriction.
Dental examination and radiograph showed a grossly carious lower
left third molar with an apical infection. The buccal vestibule at the left
posterior mandible was raised. The left buccal space and para-
pharyngeal region were fluctuant and tender to palpation. Initial la-
boratory investigations showed elevated total white blood cell count
(17.33 × 109/L), elevated neutrophil count (14.40 × 109/L), elevated
C-reactive protein (61.2 mg/L) and elevated erythrocyte sedimentation
rate (60 mm/hr), which were coherent with the clinical picture of an
acute infection. Blood cultures were taken, and they were negative for
any bacterial growth. She was diagnosed with left masticatory space

⁎
Corresponding author at: Department of Oral & Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, 168938, Singapore.
E-mail address: adrian.shi.h.y@ndcs.com.sg (H.A. Shi).

https://doi.org/10.1016/j.ajoms.2020.06.010
Received 17 April 2020; Received in revised form 16 June 2020; Accepted 23 June 2020
2212-5558/ © 2020 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd All rights reserved.

Please cite this article as: Hongyi Adrian Shi and Chung Wen Raymond Wong, Journal of Oral and Maxillofacial Surgery, Medicine, and
Pathology, https://doi.org/10.1016/j.ajoms.2020.06.010
H.A. Shi and C.W.R. Wong
Fig. 1. 28-year-old female patient presented with left facial swelling.
abscess and was admitted into the hospital immediately for intravenous
(IV) administration of amoxicillin/clavulanic acid 1000/200 mg every
8 h empirical antibiotic treatment.
A computerised tomographic (CT) scan of the head and neck with
contrast medium was performed urgently on admission, and it showed
rim-enhancing collections involving the left submasseteric space, left
medial pterygoid and parapharyngeal spaces. The grossly carious lower
left third molar with an apical infection was also well visualised
(Fig. 2). A thrombus was noted in the left internal jugular vein (IJV),
and a filling defect was observed in the superior portion of the left IJV
(Fig. 3). Filling defects of the left transverse and sigmoid sinuses were
also noted (Fig. 4). The radiographic findings suggested the metastatic
spread of the septic emboli from IJV, which caused thrombosis of the
left transverse and sigmoid sinuses. Therefore, she was diagnosed with
Lemierre’s syndrome secondary to odontogenic infection. A chest
radiograph was performed urgently, and no abnormality was detected.
After consultation with an infectious disease physician, the empirical
antibiotic regime was changed to IV metronidazole 500 mg every 8 h
and IV ampicillin 500 mg every 6 h.
Within a day after admission, the patient underwent an urgent in-
cision and drainage procedure of the abscess under general anaesthesia.
Under the effect of muscle relaxant given during general anaesthesia,
the mouth opening was improved, and the lower left third molar was
surgically removed to eliminate the source of infection. The buccal,
submasseteric, medial pterygoid and parapharyngeal spaces were ex-
plored via both intraoral and extraoral incisions. A large amount of pus
Fig. 2. Axial view of the CT scan showing a grossly carious lower left third
molar with an apical infection.
2
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx
Fig. 3. Coronal view of the CT scan with IV contrast shows thrombosis in the
left internal jugular vein with a filling defect in the superior portion.
was drained and drains were inserted into the drainage sites. The pus
culture showed isolates of Fusobacterium necrophorum and Streptococcus
pyogenes. She was continued on the same antibiotic regime of IV me-
tronidazole 500 mg every 8 h and IV ampicillin 500 mg every 6 h
postoperatively.
Postoperatively, the patient was kept intubated to protect her
airway and transferred to the intensive care unit for observation for 1
night. Her postoperative recovery was uneventful, and she was ex-
tubated the following morning (postoperative day 1). After consultation
with a neurosurgeon and a vascular surgeon, it was decided that neu-
rosurgical intervention and anticoagulation therapy were not required.
Subsequently, the patient was transferred to a general ward on post-
operative day 1 and monitored closely.
The patient’s fever lysed immediately after the surgery, and her vital
signs remained within normal limits during her whole admission. Her
mouth opening also improved, and her facial swelling subsided sig-
nificantly. Subsequent laboratory investigations were performed to
trend the inflammatory markers (Fig. 5), and the last result before
discharged showed normal white blood cell count (6.13 × 109/L),
normal neutrophil count (4.35 × 109/L), normal C-reactive protein
(4.5 mg/L) and improved erythrocyte sedimentation rate (20 mm/hr).
Overall, based on laboratory and clinical findings, the patient re-
sponded quickly and very well to the treatment provided.
The intraoral and extraoral drains were non-productive by post-
operative day 3, and they were removed. The patient was discharged
well 5 days after the surgery and was discharged with 3 weeks of per-
oral metronidazole 400 mg every 8 h and per-oral amoxicillin 500 mg
every 8 h. The course of treatment during admission is represented in
Fig. 6. In total, she completed a total of 4 weeks of antimicrobial
therapy (IV and oral). Upon subsequent reviews, her infection com-
pletely resolved, and she did not suffer any neurological deficit.
3. Discussion
Lemierre’s syndrome is characterised by an initial infection which
rapidly progresses to cause thrombophlebitis of the IJV. The throm-
bophlebitis is typically ipsilateral to the side of infection, although cases
with contralateral thrombophlebitis have been reported before [6]. The
thrombus from the IJV can form septic emboli and spread to other vital
organs. This results in metastatic infection and septicaemia, which can
exacerbate the fatal prognosis of this syndrome.
H.A. Shi and C.W.R. Wong
Fig. 4. Filling defects due to thrombosis of left sigmoid (A) and transverse (B) sinuses of the brain.
Lemierre’s syndrome is often described as a rare but potentially life-
threatening condition of the pre-antibiotic era and has been mostly
forgotten [7]. However, a systematic review has suggested that the
syndrome is making a comeback due to increasingly virulent and an-
tibiotic-resistant microorganisms [4]. If left untreated, Lemierre’s syn-
drome has a high estimated mortality rate of between 80–90 % in the
pre-antibiotic era [3]. With the advent and routine use of antibiotics to
treat infections in modern medicine, the current mortality rate has re-
duced and is estimated to be 5–9 % [4,8,9].
The overall incidence of Lemierre’s syndrome is estimated to be
0.8–1.5 cases per million persons per year [10,11], so it is considered a
rare disease. Studies have also shown a higher incidence in young
adults in the second and third decades of life with no predilection for
gender [4,10,11]. The most common cause of Lemierre’s syndrome is an
infection in the oropharynx, such as tonsillitis [4,12]. The other causes
include parotitis, mastoiditis, middle ear infections and odontogenic
infections [13]. Odontogenic infection is an uncommon cause of
Fig. 5. Trends of inflammatory markers during admission.
3
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx
Lemierre’s syndrome as it only accounts for 1% of cases reported in the
literature [4,12,14–25]. Therefore, it can be easily overlooked during
the diagnosis of a patient presenting with Lemierre’s syndrome [26].
A summary of case reports on Lemierre’s syndrome from odonto-
genic cause (Table 1) is collated [4,12,14–25]. Of the 14 cases found in
literature, including this case, the mean age of patients is 38 years
(range 17–78 years) and 64 % of them were male. Most of the cases
reported involved mandibular molars which were also the case in our
patient. Nine out of 14 cases (64 %) had metastatic infection spread to
the lungs while only 3 cases (21 %) had intracranial involvement. It is
interesting to note that the bacteria cultured from these cases varied
widely with only 1 case isolating Fusobacterium necrophorum as the
single pathogen. Treatment invariantly involved a period of anti-
microbial therapy depending on the culture results, although the period
of antimicrobial therapy varied between 3–8 weeks. Only 6 cases (42
%) required anticoagulation therapy which is reflective of the literature
on this controversial topic, and the treatment outcome was positive in
H.A. Shi and C.W.R. Wong
Fig. 6. Summary of treatment during admission.
all cases.
There are 2 theories on how thrombophlebitis of the IJV is formed
[5,27]. The first theory is the result of an infection in the oropharyngeal
region which spreads directly to the adjacent lateral pharyngeal space
and through the carotid sheath, which contains the IJV. Another theory
is the extension of an existing thrombophlebitis from the peritonsillar
veins or lymphatic channels into the IJV [28]. The evidence is still in-
conclusive to support either theory.
From the IJV, metastatic infections can spread to many organs. The
most common organ to be affected is the lungs when the septic emboli
metastasise through the pulmonary vessels [9]. Other organs which can
be affected are the joint, muscle, bone, liver, skin, spleen and heart. It
can also spread to the brain and cause meningitis, epidural or subdural
abscess, thrombosis of the cavernous, sigmoid, transverse or lateral si-
nuses and stroke [11]. Our case is an example whereby the embolic
from the IJV caused thrombosis of the left sigmoid and transverse si-
nuses. Fortunately, our patient did not suffer from any neurological
symptoms or deficit.
Patients with Lemierre’s syndrome commonly present with a sore
throat, dysphagia, trismus and cervical lymphadenopathy due to the
presence of local infection in the oropharyngeal region. As the infection
progresses, they can present with fever, chills, rigours accompanied by
unilateral swelling and tenderness of the neck along the sternocleido-
mastoid muscle. The laboratory investigations typically show elevated
white blood cell count, neutrophilia and an elevated CRP count due to
the infection [9].
Patients with metastatic infection can present with varied signs and
symptoms depending on the organs affected. Those with septic emboli
in the lungs can present with cough, dyspnoea pleuritic chest pain,
haemoptysis caused by pleural effusions, abscesses and empyema [29].
The metastatic infection can also manifest as septic arthritis, ar-
thralgias, osteomyelitis, pericarditis, hepatomegaly, splenomegaly,
jaundice and renal insufficiency [9,30]. Bacterial toxins, such as lipo-
polysaccharide, can induce massive secretion of cytokines by the im-
mune cells and lead to systemic inflammatory tissue injuries. Ulti-
mately, patients can succumb to septic shock and organ failure [31].
Fusobacterium necrophorum is the most common etiologic pathogen
of Lemierre’s syndrome and accounts for about 80 % of the cases re-
ported [23,32–34]. Mixed infection and other pathogens have also been
cultured, and these include other Fusobacterium species, Streptococcus,
Staphylococcus, Peptostreptococcus and Enterococcus species [5]. In some
cases, no bacteria could be cultured, and it was surmised to be due to
empirical antibiotic administration before the pus was taken for culture
[20,27]. Fusobacterium necrophorum and Streptococcus pyogenes were
cultured from the pus in this case.
Fusobacterium species are gram-negative, non-motile, non-
4
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx
sporulating, pleomorphic and anaerobic bacilli with filamentous ends,
and they are a common flora of the oropharynx [35]. It has been pos-
tulated that the leukotoxin and endotoxin produced by Fusobacterium
necrophorum, as well as its ability to aggregate platelets, are the primary
virulence factors in establishing and overcoming host defences. These
virulence factors and the septic pro-coagulant cascade have been at-
tributed to its ability to develop associated septic thrombi in Lemierre’s
syndrome [36]. Fusobacterium necrophorum infection has a 5–9% mor-
tality rate even with antibiotic treatment [37].
Streptococcus pyogenes is a beta-haemolytic bacterium that belongs
to Lancefield serogroup A and is also known as group A streptococcus.
Streptococcus pyogenes are gram-positive, non-motile and non-sporing
cocci which colonise the throat or skin and are responsible for several
suppurative infections and diseases such as pharyngitis, scarlet fever
and impetigo [38,39]. Group A streptococcus is also well-known for
causing streptococcal toxic shock syndrome, rheumatic fever, necro-
tising fasciitis which can be life-threatening [40,41]. This bacterium
remains acutely sensitive to penicillin. The mechanism by which
Streptococcus pyogenes contribute to the development of thrombophle-
bitis in Lemierre’s syndrome is unknown.
The mainstay of treatment for Lemierre’s syndrome is early diag-
nosis and prompt use of appropriate antibiotics [42]. The diagnosis of
Lemierre’s syndrome depends on the identification of the jugular ve-
nous thrombosis in a high-resolution CT scan [4]. The thrombus ap-
pears as a hypodense intraluminal structure with no enhancement after
contrast and causes a non-enhancing luminal filling defect in the af-
fected vessel. Magnetic resonance imaging and doppler ultra-
sonography can also be used for diagnosis. A chest radiograph should
be taken to rule out pulmonary involvement since the lungs are the
most common site of spread. The chest radiograph will show multiple
nodular infiltrates suggesting of septic emboli spread in cases with
lungs involvement [34].
The antibiotic selected to treat Lemierre’s syndrome should be
empirical at the start of treatment to provide adequate coverage of the
most common causative microorganisms. Subsequently, targeted anti-
biotic therapy should be used when bacteria are isolated in culture.
There is currently no consensus on the ideal antibiotic regime. Various
antibiotics have been proven to have in vivo activity against
Fusobacterium species, including lincomycin, clindamycin, minocycline,
metronidazole, penicillin and carbenicillin. Most authors have re-
commended the use of metronidazole and a beta-lactam agent, such as
penicillin, for a period of a few weeks although there is also no con-
sensus on the ideal dosage and total duration of antibiotic therapy
[10,32]. Similarly, our patient was treated with metronidazole and
ampicillin/amoxicillin as a targeted therapy for a total of 4 weeks (IV
and oral). The perceived advantages of metronidazole are its excellent
 Table 1
Summary of case reports on Lemierre’s syndrome from odontogenic source.
No. Authors and Age (years) Sex Odontogenic cause Presentation Metastatic infection Cultures Imaging for Treatment Outcome
Year IJV

1 Scopel Costal 34 F #48 pericoronitis Thoracic pain, dyspnoea, fever, respiratory insufficiency Lung: Bilateral pleural Negative US I&D Discharged well
et al. 2019 [14] (hypoxemia, hypercapnia, and respiratory acidosis), effusion, restrictive CT Extractions after 60 days
H.A. Shi and C.W.R. Wong

trismus and submandibular oedema atelectasis Antimicrobial therapy 5.5 Final status
Kidney: Acute renal weeks unspecified
dysfunction Anticoagulation therapy
General: Septic shock (unspecified duration)
Haemodialysis
2 Bagheri et al. 48 M Post upper right Dyspnoea, cough, light-headedness, neck swelling, None Not taken CT Antimicrobial therapy 3 Final status
2018 [15] molar extraction plethoric facies, prominent jugular vein, swollen weeks unspecified
collateral veins on the front of the chest wall and Anticoagulation therapy 3
acanthosis nigricans weeks
3 Chua et al. 53 F #48 caries Fever, vomiting and right neck swelling Brain: Aneurysm of the Klebsiella pneumoniae CT Extraction Discharged well
2017 [16] right transverse sinus US Antimicrobial therapy 4 on day 29
MRI weeks Recovered fully
Anticoagulant therapy 4
months
4 Wani et al. 22 M Unspecified Fever, chills, malaise, dyspnoea, chest pain, swelling Lung: Left pleural Prevotella anaerobes CT Antimicrobial therapy Discharged well
2016 [17] odontogenic source effusion (unspecified duration) on day 19
Thoracentesis Final status
unspecified
5 Noy et al. 2015 30 M #35 and #38 caries Fever, tachypnoea, tachycardia and Heart: Pericardial Staphylococcus capitis CT I&D Discharged well
[18] submandibular tender swelling effusion Alpha haemolytic Extractions after 24 days
Lung: Bilateral pleural Streptococcus Chest tube insertion Final status
effusion Antimicrobial therapy unspecified

5
Liver: Hepatomegaly (unspecified duration)
6 Boyd et al. 2013 17 M #47 caries Dysphagia, pain, toothache, bilateral submandibular Lung: Left Streptococcus CT I&D Discharged well
[19] and submental swelling, and pleuritic chest pain pleural effusion anginosus Extraction after 1 month
Antimicrobial therapy 8 Final status
weeks unspecified
Anticoagulation therapy 4
months
Tracheostomy
Chest tube insertion
7 Kim et al. 2013 71 F Post #17 extraction Fever, pain in the right temporomandibular joint, Brain: Right sigmoid Negative CT I&D Discharged well
[20] abscess of right masticatory and parotid area sinus thrombosis Antimicrobial therapy 4 after 7 days
weeks Recovered fully
8 Rosado et al. 38 M #48 caries Right submandibular cellulitis, sublingual swelling, Lung: Right obstructive Streptococcus CT I&D Discharged well
2009 [12] respiratory distress and delirium atelectasis and pleural salivarius Extraction after 60 days
effusions Antimicrobial therapy 6 Recovered fully
weeks
9 Ogugua 2009 24 M Periodontitis Fever, dyspnoea, abdominal pain, vomiting, diarrhoea, Lung: Bilateral pleural Fusobacterium US I&D Discharged well
[21] anorexia, body aches, jaundice, cervical effusions necrophorum Antimicrobial therapy 6 after 20 days
lymphadenopathy and tenderness over the left weeks Recovered fully
sternocleidomastoid muscle Anticoagulant therapy
(unspecified duration)
10 Malis et al. 23 M #18, #28, #38 and Fever, left submandibular and neck swelling, trismus, Heart: Pericardial Alpha haemolytic CT I&D Discharged well
2008 [22] #48 extractions bilateral pleuritic chest pain effusion Streptococcus Antimicrobial therapy 8 after 26 days
Lung: Bilateral pleural weeks Recovered fully
effusions with atelectasis
11 Juárez Escalona 36 M #48 caries Right mandibular swelling, fever, cough with purulent Lung: Bilateral Streptococcus CT I&D Recovered fully
et al. 2007 [23] expectoration, left pleuritic pain and dyspnoea pulmonary abscesses intermedius Extraction
Bacteroides fragilis Antimicrobial therapy
(unspecified duration)
(continued on next page)
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H.A. Shi and C.W.R. Wong Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (xxxx) xxx–xxx

activity against Fusobacteriumspecies and good penetration into tis-

Recovered fully
sues. Penicillin is not recommended as the sole antibiotic of choice as

Final status
certain strains of Fusobacterium necrophorum have been reported to have

unspecified
Outcome

resistance to penicillin from its beta-lactamase production [43].

The literature on anticoagulation therapy, with heparin or warfarin,
for treatment of Lemierre’s syndrome remains hugely controversial. To
date, the efficacy of anticoagulation therapy in Lemierre’s syndrome
Anticoagulation therapy
Antimicrobial therapy 4

Antimicrobial therapy 6

(unspecified duration) has only been assessed in case reports and small series. No randomized
controlled trials have been conducted to assess the risks and benefits of
anticoagulation therapy and understandably so, due to the rarity of the
syndrome. Anticoagulation therapy for Lemierre’s syndrome has been
Treatment

suggested by some authors as adjunctive therapy to prevent extension

All teeth are denoted in FDI notation. IJV, internal jugular vein; I&D, incision and drainage; CT, computed tomography; US, ultrasonography; MRI, magnetic resonance imaging.
weeks

weeks
I&D

of the thrombus in the IJV or embolisation [44]. They also posited that
anticoagulation therapy might help to speed up recovery by dissolving
Imaging for

the thrombus and exposing bacteria to a higher concentration of anti-

biotics. Anticoagulation therapy has been suggested to start within
IJV

48−72 h of diagnosis if there is clinical deterioration, but there is no

CT

CT

consensus on the required duration for anticoagulation therapy

[45,46]. Drawing reference from CHEST guideline on antithrombotic
therapy, a minimal of 3 month duration appears to be recommended for
Fusobacterium

such cases [47].

nucleatum
Negative
Cultures

Some authors indicated that anticoagulation therapy should not be

routinely prescribed for Lemierre’s syndrome [48]. They have argued
that the elimination of infection source and resolution of the infection
through antimicrobial therapy suffice as the standard of care since the
thrombus is caused by an infection process [27]. Furthermore, antic-
pulmonary abscesses
Metastatic infection

oagulation therapy carries a risk of bleeding and resolution of the IJV

Lung: Bilateral

thrombosis has been shown to occur spontaneously without antic-

oagulation therapy in most cases [49,50]. Overall, there is insufficient
evidence to support the routine use of anticoagulation therapy except in
None

cases with progressive thrombi propagation and clinical deterioration

that persist despite aggressive therapy [48,51]. For our case presented,
Right facial swelling, odynophagia, fever, malaise and

the patient was not indicated for anticoagulation therapy because she
showed rapid clinical improvement after initiation of antimicrobial
therapy and drainage surgery, and did not have any neurological def-
icit.
Fever, headache and mild neck stiffness

Metastatic infection to the brain and its clinical manifestations has

been reported to occur in 30 % of the cases in a systematic review by
Karkos et al. with meningitis being the most common [4]. Another
review found that sinus thrombosis occurs in only 5% of patients suf-
fering from Fusobacterium infection [10]. The literature is inconclusive
on whether anticoagulant therapy is beneficial for sinus thrombosis
[52]. Consultation with a neurosurgeon and close monitoring for neu-
rological deficit is prudent for such cases.
Presentation

It is imperative to note that the management of Lemierre’s syn-

trismus

drome should include eliminating the source of infection as early as

possible, and drainage of abscess as illustrated in our case. Standard
supportive care for respiratory symptoms and hemodynamic im-
Odontogenic cause

balances may also be required. Management of complications and se-

Dental caries and

quelae of metastatic infection will require a multidisciplinary approach.

periodontitis
Post dental

Secondary complications from lung involvement such as empyema or

treatment

pneumothorax should be managed by chest tube placement.

Sex

4. Conclusion
M
F
Age (years)

This article provides a literature review and reports a case of in-

tracranial extension of Lemierre syndrome from an odontogenic cause
78

44

which caused thrombosis of left sigmoid and transverse sinuses. This

case report illustrates how prompt diagnosis, with appropriate medical
Tan et al. 2003
Table 1 (continued)

and surgical management, resulted in a positive treatment outcome

Authors and

Ghaly 2003

without the need for anticoagulation therapy. This life-threatening

syndrome cannot be overlooked by Oral and Maxillofacial surgeons
Year

[24]

[25]

who treat odontogenic infection regularly.

No.

12

13

6
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