You've probably seen influencers, science communicators and other health-related people talking about the risks of popping a pimple in the so-called "triangle of death," which is located on the face around the nose, as this friendly patient explains in his TikTok video.
@enfermerojorgeangel Triangle of death #health #death #grain #curiosity #didyouknow ♬ original sound - Nurse Jorge Ángel
What is the triangle of death?
The “Triangle of Death” face area that forms an imaginary triangle with its base on the line that connects the corners of the mouth and its vertex between the eyebrows (just above the bridge of the nose). This triangle includes the nose and the upper part of the lip.
The term may sound dramatic, but it refers to a real medical risk: infections in this area can quickly spread to the brain due to a peculiarity in facial anatomy.
What is special about this area?
The face is full of blood vessels and veins that carry blood not only between the skin and the rest of the body, but also between the skin and the brain. Within the “triangle of death,” the veins that drain blood from the nose and upper lip connect directly to the cavernous sinuses, which are large veins located at the base of the skull, around the brain.
Normally, veins have valves that prevent blood from flowing in the wrong direction. However, facial veins lack valves, allowing blood to flow in both directions. If an infection occurs, such as a boil, infected pimple, or open wound, bacteria can use these blood vessels as highways to the brain.
Connection with the brain and cavernous sinuses
The biggest danger is that the infection can reach the cavernous sinuses, which are spaces filled with venous blood located on either side of the base of the skull. These cavernous sinuses are surrounded by critical structures, such as the cranial nerves that control eye movements and facial sensations. If the infection reaches the cavernous sinuses, it can lead to cavernous sinus thrombosis, an extremely serious condition that causes blood clots to form in these veins. These clots can block blood flow from the brain, causing some of these very serious complications:
- Meningitis: an inflammation of the membranes covering the brain and spinal cord.
- Brain abscesses: collections of pus in the brain that can be fatal if not treated promptly.
- Septic thrombophlebitis: inflammation of the veins due to an infection that causes blood clots.
Examples of common infections in this area
- Severe acne: Acne on the upper lip or around the nose that becomes infected can be particularly dangerous. Squeezing a pimple or boil in this area can allow bacteria to penetrate the skin and enter the bloodstream.
- Wounds or cuts: Even something as small as a cut or scrape within this triangle can be a gateway for bacteria like Staphylococcus aureus or Streptococcus.
- Sinus infections: The paranasal sinuses, which are near the triangle, can also cause problems. Severe sinusitis can spread from the nasal cavity into the cavernous sinuses.
Diagnosis and treatment
If an infection in this facial area shows signs of spreading or worsening (fever, headache, increasing swelling or redness), it's crucial to seek medical attention right away. A doctor might perform blood tests and imaging tests such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan to check whether the infection has progressed to the cavernous sinuses or the brain.
Treatment may include:
- Intravenous antibiotics to stop the bacterial infection and prevent it from spreading to the brain.
- Anticoagulants can be used if there is already cavernous sinus thrombosis to prevent the clots from getting worse.
- Surgical drainage: In severe cases, it may be necessary to drain abscesses or remove infected tissue.
Real risk
With the advent of antibiotics, the risk of dying from a facial infection has greatly decreased. However, infections in the triangle of death are still dangerous if not treated quickly. People who have weakened immune systems, such as diabetics or those with chronic infections, are at higher risk of complications if they get an infection in this area.
The “Triangle of Death” is not a constant threat, but it is a warning about the importance of treating facial infections in that area quickly. Although serious cases are rare, the unique anatomy of facial veins means that, if ignored, a simple infection in this area can have serious consequences, including brain infections. That’s why doctors advise not to manipulate pimples or wounds in this area and to be alert for any signs of severe infection.
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