July 8, 09 35 YOM presents to dental clinic (no significant medical history, otherwise healthy, no allergies) with “swelling on right side of the face and trismus. Unable to do intra-oral examination. Referred to Kenyatta National Hospital.”
August 1, 09 Dx- Trismus, Periocoronitis secondary to impacted #32.
Plan- Take to Surgery for GA (because of trismus) and surgical removal of impacted #32.
August 3, 09 Kijabe Hospital. Consent, GA, Throat Pack placed. LA, Buccal Flap raised adjacent to #32. #32 Sectioned and removed completely without incident. 3 Chromic sutures to close. Rinse with sterile saline. Throat pack removed. Patient awake with out adversity.
Rx- Pen V-K, Paracetamol, Ibuprofen
August 10, 09 Healing WNL. No signs of bleeding, pus, or infection. Trismus still present (opening of 10 mm). Encourage physiotherapy with finger excercises.
October 12, 09 Painful swelling on right side persists. Masseteric Space infection. OPG and PA shows no residual root tip.
October 21, 09 Patient reports abscess draining intraorally (distal to #31). #32 socket not completely closed. Rx- Amoxicillan, Flagyl.
October 27, 09 Pus still draining distal to #31. Limited opening still at 10 mm. OPG taken..poor quality. Rx- Augmentin
November 11, 09 #32 Socket now healing. Trismus still present and swelling masseteric space (painful to palpation). Rx- Chlorohexidine Mouthrinse BID and finger exercises to increase opening.
December 10, 09 R side Masseteric Space swelling decrease in size, Max opening improved to 20 mm. No visible pus. Saliva normal flow and volume. Rx. Ibuprofen.
January 13, 10 Swelling reoccurs on R side Masseteric area. Pus discharge distal to #31. Opening decrease to 10 mm.
Tx- Curetted area distal to 31. No bony fragment, cyst, or tooth roots removed.
Intra-oral and extra-oral aspiration attempted but with no aspirate achieved.
Plan- refer to KNH for better imaging.
February 21, 2010 Patient returns with OPG (good quality). Shows mixed RO RL area in R condyle tracking near the IA foramen. Masseteric space infection increased in size and painful to palpation. Pus still draining intra-orally.