A 17-year-old female visits the family dermatologist because of severe facial acne. During physical examination it was found that there was a rather obvious and painful lesion on the side of her nose. The patient was given antibiotics and warned not to press or pick at the large, inflamed swelling. If she were to squeeze, prick, or incise such a lesion in the area between the eye and the upper lip, or between the eye and the side of the nose, the infection could spread to the cavernous sinus. Which of the following pathways of spread of infection would be most typical?
A 17-year-old female visits the family dermatologist because of severe facial acne. During physical examination it was found that there was a rather obvious and painful lesion on the side of her nose. The patient was given antibiotics and warned not to press or pick at the large, inflamed swelling. If she were to squeeze, prick, or incise such a lesion in the area between the eye and the upper lip, or between the eye and the side of the nose, the infection could spread to the cavernous sinus. Which of the following pathways of spread of infection would be most typical?
π‘ Explanation
**Core Concept**
The cavernous sinus is a group of veins located near the base of the brain, and it is prone to infection through the spread of pathogens from the face, particularly through the orbit and the nasal cavity. This is due to the close anatomical proximity of these structures to the cavernous sinus.
**Why the Correct Answer is Right**
The infection would most likely spread through the ophthalmic veins to the cavernous sinus. The ophthalmic veins are a group of veins that drain the eye and the surrounding facial structures. They are unique in that they lack valves, which allows the spread of infection to occur more easily. The infection would then travel through the superior and inferior ophthalmic veins to the angular vein and eventually drain into the cavernous sinus. This is a typical pathway of spread for infections such as herpetic or bacterial infections.
**Why Each Wrong Option is Incorrect**
**Option A:** Spread through the facial veins would be a more superficial route and would not typically lead to cavernous sinus thrombosis.
**Option B:** Spread through the nasal cavity would be more typical of a sinusitis infection, rather than a facial acne-related infection.
**Option C:** Spread through the lymphatic system is not a common pathway for the spread of infection to the cavernous sinus.
**Clinical Pearl / High-Yield Fact**
Remember the "danger triangle" of the face, which includes the area between the eye and the upper lip, and between the eye and the side of the nose. Infections in this area can spread to the cavernous sinus through the ophthalmic veins, making it a high-risk area for cavernous sinus thrombosis.
**Correct Answer:** C.
β Correct Answer: A. Nasal venous tributary to angular vein, to superior ophthalmic vein, then to cavernous sinus
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