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The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
The “danger triangle” of the face refers to sites on the face from which infection may spread to the cavernous sinuses, i.e., deep internal sections of the dural venous sinus network. The complexity of the intracranial venous channels and its bidirectional flow facilitate the spread of infection from the nose, tonsils, and eyes into the cavernous sinuses, deep inside the cranium.
Eye on the Enigmatic Link: Dysbiotic Oral Pathogens in Ocular Diseases; The Flip Side
Published in International Reviews of Immunology, 2021
Anatomical proximities: Previously, it was noticed that undetected dental disease had resulted in the loss of teeth and consequently vision-threatening eye disease in animals. Ocular manifestations of dental disease were seen in dogs and cats where the anatomical proximity between posterior maxillary (upper back) teeth and the orbit has been correlated in this regard [188]. There are no direct human cases presented with this scenario. Given this setting, the human eye is shown to maintain an immune-privileged state [189,190] like that of the brain, as the entry of immune cells to this organ was thought to be nonexistent [191]. Nonetheless, recent studies show that immune cells are recruited to the eye following retinal injury through infections or inflammation. This compromises the survival of neurons in several models [192]. As illustrated by earlier studies, the anatomic accessibility of oral microflora to the bloodstream via the ulcerated periodontal epithelium might facilitate bacteremia and systemic spread of bacterial products, components and immune macro-complexes. In a similar setting, we would not ignore the “danger triangle of the face” which is a little imaginary triangle extending from the corners of the mouth up-to the nasal bridge (Figure 5B). The direction and pattern of blood supply to the nose and the venous drainage from the facial veins and pterygoid plexus cause an infection traveling from that area to spread into the cavernous sinus (a paired area posterior to the maxillary sinuses and lateral to the pituitary gland) resulting in cavernous sinus thrombosis. It is a fatally serious condition that occurs with the uncontrolled spread of infection in the danger triangle of the face, specifically the upper jaw, eyes and the nasal region. We hypothesize that this anatomical proximity could be attributed to the plausible metastatic dissemination of periodontal pathogens, especially tissue-invasive P. gingivalis or their products to the orbital structures via the blood or lymphatic circulation, where they possibly elicit aberrant host responses.