Cases reported "Periodontal Abscess"

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1/11. Postanginal septicaemia with external jugular venous thrombosis: case report.

    Postanginal septicaemia is a syndrome of anaerobic septicaemia, septic thrombophlebitis of the internal jugular vein, and metastatic infections, that follows a localized infection in the area drained by the large cervical veins. The syndrome was well-known and often fatal in the preantibiotic era. It is now rather rare, presumably as a result of the almost routine use of prophylactic antibiotics. The symptoms are classic, and it should be suspected in any case where septicaemia and metastatic lesions are preceded by a head and neck infection. We report a case that is typical, except that branches of the external jugular vein were thrombosed. To our knowledge this has not been reported previously.
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2/11. Streptococcal infection and necrotizing fasciitis--implications for rehabilitation: a report of 5 cases and review of the literature.

    Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.
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3/11. Undifferentiated malignant neoplasm involving the interdental gingiva: a case report.

    BACKGROUND: Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva. methods: A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry. RESULTS: Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer. CONCLUSION: This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.
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4/11. Bedside ultrasound of the soft tissue of the face: a case of early ludwig's angina.

    A case is reported of a 38-year-old man presenting with early ludwig's angina. It is difficult to differentiate superficial from deep infections of the face and neck by physical examination alone. The diagnosis of this condition with bedside soft tissue ultrasound of the face is described. ludwig's angina is an uncommon infection of the deep tissues of the face and neck that usually evolves from more superficial infections such as dental abscesses.
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5/11. Spread of infectious complications of odontogenic abscess detected by technetium-99m-HMPAO-labeled WBC scan of occult sepsis in the intensive care unit.

    We report a rare case of odontogenic abscess, detected while the patient was in the intensive care unit (ICU), which resulted in sepsis and the patient's death due to mediastinitis, skull osteomyelitis, and deep neck cellulitis. The detection of infectious focus in occult sepsis in ICUs is usually difficult because many diagnostic procedures cannot be conveniently performed. The use of 99mTc-hexamethylpropyleneamineoxime-labeled white blood cells scan allowed accurate diagnosis and appropriate surgical drainage.
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6/11. Iatrogenic subcutaneous cervicofacial and mediastinal emphysema.

    subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes. Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues. The many causes include head and neck surgical procedures, tracheal and esophageal trauma, intraoral trauma, foreign bodies and neoplasms of the aerodigestive tract, and pulmonary barotrauma from mechanical ventilation or in patients with pulmonary disorders. subcutaneous emphysema secondary to active injection of air has recently been reported following certain dental procedures. An interesting case of diffuse cervicofacial and mediastinal emphysema following a difficult extraction of an infected lower molar tooth with a high-pressure air drill is presented. The patient required airway observation and high-dose antibiotic therapy. Early recognition of this unique problem is essential in preventing such life-threatening complications as airway obstruction, mediastinitis, deep neck infection, and cardiac failure. Diagnostic and therapeutic recommendations are included.
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7/11. Cutaneous sinus of dental origin: a diagnosis requiring clinical and radiologic correlation.

    Cutaneous sinuses may arise from chronic dental infections. These sinus tracts usually appear as suppurative lesions of the chin or neck. Diagnosis is made by palpating the lesion and by radiologic examination demonstrating periapical dental abscess. Treatment with dental extraction or root canal results in resorption of the inflammatory fistula. Since many patients with sinus tracts of dental origin do not have any complaints of tooth or mouth pain, the correct diagnosis may be overlooked by the unsuspecting clinician.
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8/11. Deep neck infection complicated by diabetes mellitus. Report of a case.

    A poorly controlled diabetic patient who developed a life-threatening deep neck infection from a periodontal abscess is presented. Despite treatment reflecting the current surgical and medical approach to management of this infection, he failed to show the consistent improvement that would be expected in a nondiabetic patient. The physiologic differences in the defense systems of the diabetic versus the nondiabetic host are discussed, and general guidelines for identification of the diabetic patient are offered.
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9/11. head and neck infection after renal transplantation.

    Infections of the head and neck were identified in 12 (9%) of 128 consecutive patients undergoing renal transplantation. The infections included sinusitis, otitis media, dental abscess, ludwig's angina, parotitis, and nasal abscess. A significant correlation was found between the development of infection and juvenile-onset diabetes but not with previous splenectomy. None of the infections occurred during treatment of rejection episodes with corticosteroids. The clinical presentations and microbiologic agents causing the infections were similar to those found in nonimmunosuppressed patients.
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10/11. Cutaneous odontogenic sinus.

    A case report and discussion of cutaneous odontogenic sinus tracts, frequently encountered but often misdiagnosed and mistreated, are presented. awareness that periapical dental abscesses are the most common etiologic factor of cutaneous sinus tracts involving the face and neck will facilitate their early diagnosis and prevent needless treatment or anxiety for the patient. These lesions are often misinterpreted as chronic, resistant to therapy, pyogenic nodules, or granulomas. A high degree of suspicion is required for making the correct diagnosis, and dental roentgenographic studies should routinely be obtained in all such lesions. Permanent healing cannot be achieved unless the original site of infection is located and eradicated.
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