58 male pt referd from medicine op( admittd with fever chills..)for evaluation of diffuse swelling RT side face...( fbs 350 mg...tlc 23000....esr 100) patient c/o parathesia RT maxillary area. o/e diffuse swelling RT maxillary area with tenderness over RT infra orbital margin RT maxillary area..relative exophthalmos RT eye.. no relevant findings intra oraly. pns inconclusive CT advised see sinuses diagnosis ent consltn advised

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Maxillary sinusitis developing orbital cellulitis systemic iv purezone I/v1gm bd augmentin 625 mg tds ibubrufen 600mg bd ENT surgeon advise &active participation may need Sinus wash x-ray sinus mri orbit .Continue aggressive antibiotics follow day 12 hourly

Thank u sir
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Maxillary abcess with developing orbital cellulitis .Insulin control of blood sugar with glucose chart regular monitor,inj purezone 1gm iv 12 hourly .Maxillary Antral wash tad augmentin 625 mg tds ibubrufen 600mg bd Serratiopeptidase , May require Caldwell Luck operation through above gums to reach sinus drainage for operation follow up 12 hourly with ENT surgeon active participation

Thank you sir
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Acute pan sinusitis with developing orbital cellulitis. May be an acute invasive fungal sinusitis. Fungal hyphae and allergic musin has to be checked. EOM moments has to be checked if compromised can be developing orbital cellulitis. If proptosis.. is present have to see in view of cavernous sinus thrombosis and rule out a pulsatile proptosis. Sir, the CT not able to make out anything if possible add coronal cuts aswell.

Get an opg done....check the periodontal status .......check carious teeth.....Usually the peri orbital oedema is a result of the renal ailments ......FBS is on high end ......esr indicates a chronic infection.....have u checked rft and s.uric acid urea and creatinine levels .......???????

Intraorally no relevant findings.sir
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SEPTICEMIA.......?????.. DEVELOPING ORBITAL CELLULITIS...... MAXILLARY SINUSITIS......= PT IS DIABETIC...... INVESTIGATIONS REQUIRED ......... 1 BLOOD EXAM........ BLOOD CULTURE / SENSITIVITY TEST LFT KFT ELECTROLYTES PROTEINS........ 2 COMPLETE URINE EXAM....... 3 X RAY.S.........PNS VIEW . .......PA VIEW MAXILLA . ......LATERAL OBLIQUE VIEW MAXILLA ..........OPG MANAGEMENT............START INITIALLY WITH........ INJ R LACTATE I/V INJ SALBECTUM + PIPERACELLIN I / V INJ METROGYL I/V INJ POLYBION ........... INJ DICLOFENAC TAB SERRATIOPEPTIDASE + ACECLOFENAC + PCM TREATMENT AS ADVISED ALREADY FOR DIABETES...... REST OF THE TREATMENT .........AS PER INVESTIGATIONS REPORTS...........INCLUDING DENTAL TREATMENT ....IF ANY.....

Apart from oncoming acute orbital cellulitis treatment must be done after hospitalization +drastic treatment of control of hyperglycaemia

Maxillary sinusitis developing orbital cellulitis.

Pt has pan sinusitis with immenent orbital cellulitis.Needs to treated with high broadpectrum antibiotics with adequate blood sugar control

Thank u mam
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Rule out cavernous sinus thrombosis Any infection in the periorbital area may results in cavernous sinus thrombosis due to direction communication through vessels of the orbital region as fever and chills is one of the most common sign cavernous sinus thrombosis HOSPITAL ADMISSION MUST Get CBC RBS/FBS SERUM ELECTROLYTE LFT RFT CHEST X-RAY URINE ROUTINE PERIPHERAL SMEAR BLOOD CULTURE start broad spectrum antibiotics i.e pipracillin with tazobactum tid Metronidazole Tid Paracetamol 650 8hrly Diclofenac sodium PPI Start insulin after general physician consultation

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