The Dangerous Area of Face "The Infections of the dangerous areas of the face" was first discussed by Ludlow in 1852. He wrote about 6 patients with minor infections of the face (a pimple or boil on the lip). Three of those patients died within a short period of admission after pinching or scratching the pimple. At that time they did not know what caused the deaths. It was not until 1883 that Sir Frederick Treves offered the first explanation as to why infections of certain areas of the face were dangerous. He correctly predicted that the cause of death in these patients was due to thrombosis of cerebral sinuses. As medical students we were taught that infection involving the area now known as "Danger Triangle of the Face" must be treated promptly as there is a big risk of patients developing Cavernous Sinus Thrombosis which could be fatal. I remember a young man who was admitted to our hospital when I was a houseman 45 years ago. He had severe infection of the face (multiple pustules). He was otherwise perfectly fit and normal. We started IV antibiotics soon after admission. However within 12 hours of admission he was dead. I can never forget this incident. The public however are still unaware of of the seriousness of the infection affecting this region. They tend to ignore and treat a pimple or a pustule in the area as they would an infection on their arm or leg. The danger triangle of the face as its name implies is a triangular area with the tip of the triangle at the medial angle of the eye and the base present covering the lower part of nose and the upper lip. See the figure. It is the area of the face from where infection can spread quickly and easily to the brain. The infection spreads through the cavernous sinus, a blood filled space connected by veins draining the danger triangle of the face. They are two in number situated at the base of the skull and very close to the brain. Symptoms of a cavernous sinus thrombosis: • a sharp and severe headache • swelling and bulging of the eyes • eye pain that is often severe More Serious Signs: As cranial nerves responsible for controlling eye movements pass through the cavernous sinus, thrombosis and infection of the sinus may cause paralysis of the muscles leading to loss of certain movement of the eye. Rarely if the swelling is considerable it may even cause pressure on the optic Chiasma causing visual disturbance. Most cases of cavernous sinus thrombosis occur when a bacterial infection in another part of the skull or face spreads into the cavernous sinuses. In around 7 out of every 10 cases, staphylococcus is responsible. It often appears a few days before cavernous sinus thrombosis. Investigations: Routine blood tests should include blood culture for pathogens. A CT scan and or MRI scan Treatment: Cavernous sinus thrombosis will need urgent active treatment in a hospital. The main treatment will be through intravenous antibiotics. The treatment can last for several weeks. The addition of steroids and anticoagulants may be needed in severe cases. Complications: Although cavernous sinus thrombosis is thought to be rare, it can affect people of all ages and once diagnosed is an extremely serious condition. Even with prompt treatment, as many as one in three people with the condition die. Around 1 in 10 people who survive will develop long-term health problems as the result of damage to their brain, such as persistent headaches and fits, or some degree of visual impairment.