A 29-year-old previously healthy man died of spread of infection from gingivitis to both parapharyngeal (pharyngomaxillary) spaces and to the cavernous sinus. The diagnosis was delayed because gingival and parapharyngeal sources of cavernous sinus thrombosis were not initially considered, and the ophthalmic congestion was believed at first to represent orbital cellulitis rather than cavernous sinus thrombosis.