ABSTRACT
Objective: This article reports a case of a chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction in a 70-year-old female diabetic patient 4 weeks after forceps extraction of the upper right 1st premolar. Case Description: Patient gave a history that prior to the tooth extraction, there was a carious cavity on the tooth, pain on mastication with background nasal congestion and post nasal drip of over one year duration. 4 weeks following extraction, there was marked right buccal and periorbital swelling. Examination by the ophthalmologist revealed rupture of the right globe with copious pus discharge from the lower eyelid of the right eye. Examination by the dental team and the Head and Neck Surgeon revealed the presence of oroantral communication with pus discharge from the oroantral fistula and the retropharyngeal area. Fasting Blood Sugar on presentation was 278mg/dl. Patient was referred to the physician for optimization of her blood sugar level.Evisceration of the right eye was carried out along with incision and drainage of the right eyelid and buccal space. Intravenous ceftriaxone 1g daily,intravenous metronidazole 500mg 8 hourly, intramuscular genticin 80mg 8 hourly, eusol A&B dressing twice daily, paracetamol per oral 1g 8 hourly, menthol crystals steam inhalation twice daily, Diazepam 5mg nocte were prescribed for the patient. Inferior meatal antrostomy with antral washout was carried out by the Head and Neck Surgeon 2 weeks after. Following surgery, patient was placed on per oral Tavanic 500mg once daily, metronidazole 400mg 8 hourly, vitamin c 100mg 8hrly,guaifenesin/pseudoephedrine 25mg nocte, diclofenac potassium 50mg twice daily and menthol crystals steam inhalation twice daily. Review of the patient four weeks' after surgery showed marked improvement in the clinical parameters of the patient, disappearance of swelling and cessation of pus from all points of previous discharge.Conclusion: Chronic maxillary sinusitis complicated by right orbital abscess with ruptured globe following tooth extraction may be considered a potential complication of forceps extraction of maxillary premolars and molars especially in a medically compromised patient. The authors hereby recommend (1) ensuring adequate medical and dental evaluation of patients before forceps extraction (2) all medically compromised patients must be optimized before forceps extraction (3) The need for multidisciplinary management of medically compromised patients with dental diseases
Subject(s)
Abscess , Eye , Maxillary Sinusitis , Nigeria , Orbital Myositis , Oroantral Fistula , Posterior Capsular Rupture, OcularABSTRACT
Objective: Congenitally missing teeth is a common dental anomaly, with the second premolars having a very high incidence after the third molars. Congenitally missing premolars may be associated with presence or absence of retained deciduous second molars. The objective of this case report is to describe the management of retained second deciduous molars with missing second premolars in a young adult patient. Case Description: This article reports a case of a 20 year old female patient, an undergraduate in a Nigerian university, who presented to the dental clinic complaints of shocking sensation in one of her teeth in the maxillary right quadrant. Clinical examination revealed presence of retained deciduous second molars, bilaterally on the mandible and the maxillary right quadrant, with congenitally missing second premolars. There was a class II carious lesion on the maxillary deciduous second molar. The patient oblivious of the condition was bothered by the shocking sensation on the maxillary deciduous second molar. Amalgam was the restorative material used to treat the carious tooth. Conclusion: It is imperative to maintain or restore the health (the anatomic and physiologic function) of the retained deciduous second molars in cases of congenitally missing second premolars