51/162. Cutaneous facial sinus tract of denture-related aetiology? A case report. A case is reported of a chronic facial sinus on the mandible. It is postulated that this was due to chronic mucosal trauma associated with a poorly adapted denture in a patient rendered immunosuppressed by poorly controlled type II diabetes. Previous treatment with antibiotics alone was unsuccessful. Healing was only achieved when antibiotics were combined with removal of the denture and improved diabetic control. ( info) |
52/162. Necrotizing fasciitis of the face: a rare but dangerous complication of dental infection. Necrotizing fasciitis of the face is extremely rare. However, dentists should be familiar with the presentation of this condition because of the suddenness of its onset, the rapidity of its spread, the resulting drastically disfiguring morbidity and the high rate of mortality associated with it. In this paper, we describe the presentation and treatment of a 57-year-old woman with necrotizing fasciitis of the face and neck due to dental causes and discuss factors in the management of this life-threatening condition. ( info) |
53/162. life-threatening thrombotic thrombocytopenic purpura associated with dental foci. Report of two cases. OBJECTIVES: Thrombotic thrombocytopenic purpura (TTP) is a rare haematological disease of unknown aetiology. This thrombotic microangiopathy is characterized by microvascular lesions with platelet aggregation. It is found in adults and can be associated with pregnancy, cancer, autoimmune diseases, bone marrow transplantation, drugs and bacterial as well as viral infections. The therapy requires a multi-disciplinary team approach involving dentistry. Even if TTP is immediately treated in an adequate manner, it still shows a mortality of up to 20%. AIM: To define a specific treatment concept for periodontal disease and decayed teeth in patients suffering from TTP based on the experiences gained from two cases. CONCLUSION: The two patient cases revealed a possible association of TTP with dental foci. Because of the severity and mortality of this disease, both prognosis evaluation and treatment standards of periodontologically compromised or decayed teeth have to be strictly followed in patients suffering from TTP. In order to avoid recurrence of TTP, it seems important to remove radically teeth of questionable prognosis. ( info) |
54/162. Characterization of streptococcus constellatus strains recovered from a brain abscess and periodontal pockets in an immunocompromised patient. BACKGROUND: There have been a number of reports of brain abscesses suggesting an odontogenic etiology. However, no efforts have been made to compare brain abscess isolates with isolates from the oral cavity using highly discriminative methods. We report a brain abscess caused by streptococcus constellatus in an immunocompromised patient where oral infection (periodontitis) was suspected to be implicated. methods: The brain abscess and oral isolates were compared by means of one phenotypic and three genetic (restriction fragment length polymorphism [RFLP], ribotyping, and random amplified polymorphic dna [RAPD]) fingerprinting techniques. RESULTS: The phenotypic method and RFLP showed identical profiles between brain and periodontal isolates, while ribotyping and RAPD showed very close similarity, with only one band difference in one of the three ribotypes and in one of the three polymorphic RAPD. CONCLUSIONS: Gene transfer by genetic recombinational events in the periodontal pocket might have been responsible for the emergence of a strain variant of S. constellatus that had the potential to cause an abscess at a distant site (brain). The importance of odontogenic sources as potential foci of infection for brain abscesses is discussed. ( info) |
| We report a case of mediastinitis complicating a dental infection in a 40-year-old male. Despite drainage of the localised neck abscess and the administration of systemic antibiotics, his submandibular abscess extended to involve the pericardial and pleural cavities. drainage procedures and thoracotomies were required to treat the empyema and purulent pericarditis. Computed tomography was used to follow the progression of disease and assess the efficacy of treatment. ( info) |
| A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, ludwig's angina remains a potentially lethal infection in which early recognition plays a crucial role. ( info) |
57/162. Intraorbital abscess: a rare complication after maxillary molar extraction. BACKGROUND: The orbit is prone to being affected by an odontogenous infection, owing to its anatomical proximity to the maxillary sinus. A possible reason for an ophthalmic manifestation of a dental abscess is extraction of an acutely inflamed tooth. CASE DESCRIPTION: The authors describe the treatment of a man who had painful swelling and redness in the area of his right eye after having a maxillary molar extracted a few days previous. A general dentist referred the patient to the clinic after he began to experience a progressive deterioration of vision of his right eye. Emergency surgical intervention prevented impending loss of vision, and subsequent healing was uneventful. CLINICAL IMPLICATIONS: To avoid serious complications, clinicians should not perform a tooth extraction when the patient is in the acute stage of a maxillary sinus infection. Appropriate diagnostic imaging and profound evaluation of the clinical state play major roles in managing the treatment of patients with inflammatory processes that involve the oral and paraoral regions. ( info) |
58/162. Orbital abscess: visual loss following extraction of a tooth--case report. OBJECTIVE: It is the purpose of this article to alert the general practitioner to the severe consequences that may result from a tooth extraction, including the loss of vision, despite the use of antibiotics. CONCLUSIONS: Early and aggressive treatment is critical in obstructing the spread of infection toward the orbits, the eyes, and eventually the brain. ( info) |
59/162. Use of interventional radiology in the management of mediastinitis of odontogenic origin. Descending necrotising mediastinitis is a rare complication of odontogenic infection. The key to diagnosis is to maintain a high index of suspicion when antibiotics and adequate surgical drainage do not lead to resolution of symptoms. Open thoracic operation to drain mediastinal collections is potentially lethal and interventional radiological techniques are thought to reduce mortality. We report the use of interventional radiology in the diagnosis, monitoring and treatment of this condition and illustrate our experience with three case reports. ( info) |
60/162. Rare complications of a dental abscess. This article describes a case involving a poorly treated odontogenic infection, which was complicated by mediastinitis, thoracic empyema, pericarditis, and ascites. A posterolateral thoracotomy was necessary as incisional surgical drainage proved to be inadequate. A multidisciplinary approach of descending necrotizing mediastinitis and its complications is essential. ( info) |