Infraorbital extension of odontogenic infection mimicking dacryocystitis

Odontogenic infections may occasionally extend superiorly into the infraorbital region, producing periorbital findings that mimic dacryocystitis and complicate diagnosis. A medically compromised woman with poorly controlled diabetes mellitus, hypertension, and ischemic cardiomyopathy presented with a 15-day history of progressive right infraorbital swelling initially suggestive of dacryocystitis. Radiographic evaluation demonstrated multiple infected teeth in the maxillary dentition, and clinically, a fluctuant palatal swelling was noted. Contrast-enhanced computed tomography revealed infraorbital soft-tissue inflammation with unilateral maxillary and ethmoid sinus mucosal thickening, consistent with maxillary sinusitis of endodontic origin with extension into the infraorbital region. Following systemic stabilization, infraorbital abscess drainage, empirical broad-spectrum intravenous antibiotics, and maxillary sinus lavage were performed. Definitive management included root canal disinfection of salvageable anterior teeth and extraction of nonrestorable posterior root stumps serving as infectious foci. Healing was uneventful, and at 18 months, the patient remained asymptomatic with complete radiographic resolution.