a patient with poor oral hygiene c/o pain in right upper teeth region ..lesion in palate ...developed extraoral facial swelling ...can't able to open his eyes...after antibiotic inj now swelling reduced but no movements in right eye pupil ...what to do next ??




This condition also has resemblance with MUCORMYCOSIS too, As nerve involvement with occular involvement is there along with poorly controlled DM Also hepatic mucormycosis, liver cirrhosis, hepatitis has been reported in association with mucocutaneous mucormycosis. (rare cases but have been reported earlier) Other d/d's could be 1.)DM induced Non Healing Ulcer wid Cellulitis 2.)Necrotizing fascitis 3.)Necrotizing sialometaplasia

Blood picture suggests borderline high due to septicemia. Clinical findings are that of SOL & Cellulitis that has involved the lateral rectus muscle of eyeball. Avd: Scan. Admit & continue antibiotics. Seek ENT, Eye & Medicine expert opinions. Proceed accordingly.

Agree with you may b due to invlvement of cannine space infection leading to cellulitis...septicemia with delayed wound healing due to DM...@Dr. Partha Sarathi Sahana sir

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Mai b the case of diabetes induced oral ulceration with delayed wound healing due to microangiopathay and utilization of protein..peripheral neuropathies with poor peripheral circulation ( right eye movements).... Put pt or strict DM monitoring up to desired level of bood sugar IV broad spectrum antibiotics..... Opthalmologist conc. Regarding ocular movements.....plz correct me????@Dr. Partha Sarathi Sahana @Dr. Shalini Singh

Can we get few more information like 1) any tenderness on percussion esp 1st molar. 2) any aspirate? 3) when you are mentioning no movement of pupil, are u refering to reaction to light or movement of eyeball?? 4) extraoral photograph 5) Hba1c Since it is responding to antibiotics, chances will be in favour of infectious origin, probably canine space infection. Though elaborate history would be requires.

Viral marker???

I think ,this condition is more likely due to diabetes, here bone loss and abscess is present.. And due to nerve compression ,there is effect on eye. Consult with any opthalmologist and neurlogist.....

Give hydrocourt inj twice a day with inj amikacine 500 Tab chymoral fort one empty stum. With ur regular medicine for quick relife from swalling Its like space infection But apears as mix doubtfull

Necrotic gingiva seen at palate dd osteomylites cab give this types of apearance too Nasalseptum deviation can see..in opg and pic

Yes this is bcoz of DM, u have to monitor all the sign and put the patient on antibiotic by iv ...sgot and sgpt also increase so dont give oral med. And also check for liver disease.

Take alcohol history

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He is diabetic

Rt que sir.....need some history too

Septicaemia.......check FBS and RBS levels ...... antibiotics analgesic medications.............opg and accessment of the damaged tissue

In MRI report of brain some infarcts are there so can't give GA ..can we operate it with LA ??

Sir I request you to plz upload biopsy report Regarded mucormycosis and uploaded d ct scan@Dr. Siddhartha Pareek

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