Atypical thrombophlebitis patterns in head and neck infections

Thrombophlebitis is a known complication of head and neck infection, which can result in propagation of infected thrombi and associated complications. While antegrade/downstream propagation of thrombus is well described—the Lemierre syndrome—thrombophlebitis can spread in atypical patterns which has specific diagnostic and treatment considerations. In this series, we highlight 6 cases of atypical thrombophlebitis patterns complicating head and neck infection, 5 of which extend intracranially. Through these pathways, head and neck infections such as oral cavity, oropharynx, or skin can be the culprit of remote, including intracranial, complications, which may be overlooked. Furthermore, understanding pathways of venous drainage and communication can help accurately diagnose thrombophlebitis patterns and associated complications.