Beyond the danger triangle, the fulminant course of a facial infection: A case report

The danger triangle of the face has a unique and highly vascularized anatomy, and therefore infections in this area pose a significant risk for fulminant spread. A 30-year-old man presented himself with right facial swelling due to a subcutaneous pustule in the right beard area, outside of the danger triangle of the face. From here, the infection was able to spread to the orbital area and structures of the central nervous systems through the valveless facial vein. Here the infection caused permanent vision loss to the right eye as a result of the damage, together with intraventricular pus, causing loss of neurological function. Despite adequate efforts for source control, the infection could not be contained and caused pulmonary infectious bilateral empyema and pulmonary abscesses. Although the patient reported feeling better, imaging studies of the brain continued to show progressive lesions, such as watershed infarctions and possible secondary infection of these lesions. After two months of treatment, the patient's health was deemed sufficient to be transferred to a specialized rehabilitation center to try and recover the neurological functions lost. Early identification and intervention in facial infections are vital to prevent complications, underscoring the need for clinician awareness. Source control and prevention of spread of the infection after identification are crucial for optimal patient outcomes. • The ‘’Danger triangle of the face’’ poses significant clinical risks for infections • Infections outside the danger triangle of the face can also spread rapidly • Early identification of facial infections is crucial to prevent complications • Ligation of the angular vein may stop the infectious spread to the brain