Case of the day

Buccal space

28 years male painless swelingg last 5 months sinus present palatal aspect 26 .. seems like bucccal space .. due to lockdown and our higher centers in red zone .. so refer not possible just to minimize the infection ..I m working on this case .. . So . more than 30 ml pus drain by syringes and then i decided to incison in bucaal vestibule and planing for extraction 24 25 26 .. It's my opinion becuse refer biopsy etc not posiible .. .. So .. need your guidance and best wishes ..

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Instead of planning to extract , just raise the complete flap and see what's in there irrigate with dilute betadine... 10time the volume you aspirated and suture it back give standard aug metro combo, try to feel and palpate whether palatal side is perforated or involved or not...

I agree
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Add chymoral forte to his prescription for 7 days and hot saline gargle for 15 days 5 times daily... take a radiograph after 7 days and again at 15 days... then we might learn something more of the case & it's course of progression.

Sure sir ... Thanks lots boss .. I will continue try to follow and and update this specialy
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Insert the 20 size gp through the palatal aspect and take a radiograph... that will further give you immense information about the offending tooth if present...

I agree
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@Prashant Singh Sir Take one clear radiograph where crown and root of 24 ,25 and 26 can be seen.As we need to figure it out if there is any caries present.Secondly,There is radiolucency periapically with all the 3 teeth so ultimately to save the teeth,RCT should be done. Since you cant proceed with pathological findings and as you already started with antibiotics then just open up the tooth and give open dressing.Let the pus drain through tooth.Avoid any surgical intervention except Incision and drainage if needed.

After open dressing ,recall the patient after 24-48 hours.CMP and start with ICM. But if you see there is no resolution of swelling then IND has to be done.Opinion from oral surgeon will be highly appreciated.
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If we start from basics... It looks like buccal space infection. Any history of reduced mouth opening??? why to extract tooth? Rx Start with antibiotic therapy for 1 week. Review after 1 week.

Mam he is under medication from February before lockdown .. from nearby dental college.. due to covid.. everything is closed .. so i decided to help him .. we r in safe zone .. most important part pus drainage done almost more than 30 ml .. after that lots of irrigation from betadin normal saline and chlorhexidine.. I m planing for extraction due to sinus present palatal aaspect 26 .. and mild swelingg too .. . And our main aim to protect teeth .. so I need guidance to go for extraction or wait and watch .. if wait than how long .... It's already worsttt ... As I fell aftrer pus drainage .. we dint have options for biopsy .. or any pathology finding ... Or refer to higher center .. so I need your valuable guidance .. thanks lots for your reply dr.
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Sir instead of extraction, access open the tooth and give open dressing and see how much pus is draining from which tooth along with antibiotic therapy.. n keep updating us about the case..

Sure mam ... Its my duty too... To update .... But no one carious ... But I will upade few more radiographs
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To be on the safer side go for culture and sensitivity of the pus and if possible FNAC and Biopsy

Sir not possible most of the pathologist in red zone and mostly higher center r closed ... My area is in safe zone ....
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Necrotising sialometaplasia Ischemic necrosis Malignant SCC

Valuable opinion
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Hello doc. What is status of 26. Giving medicine for long time is not good. Pls share x ray of 26. Is it carious? From where this space infection started. If u feel culprit is 26. Why dont u open Rct. Do proper bmp n keep caoh dressing. Put the patient on i.v. antibiotics for 3 days. It will recover i feel. You can go for extractionnof culprit tooth also. Rest you are the best judge of your case. Regards.

Thanks
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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