Maxillary Necrosis subsequent to tooth extraction!!
A 52 year old lady presented to emergency department with severe pain in right maxillary region after 1 week of the extraction of premolars and molars. The pain aggravated on bending forward and was not associated with any swelling, ulceration or foul smell. However, she complained of partial right nasal obstruction. On examination, there was a large necrotic area in right maxilla which began from canine anteriorly and went beyond maxillary tuberosity posteriorly. The patient was having a fever of 100.7°F with a raised blood pressure upto 160/90. Rest of the examination was unremarkable. A number of differentials including tuberculous osteomyelitis, tertiary syphilis, necrotizing sialometaplasia , squamous cell carcinoma, mucormycosis, aspergillosis and adenoid cystic carcinoma were made. After conducting a number of labs and VDRL tests, radiological investigations were carried out. The CT scan showed a large area of alveolar destruction involving some portion of right nasal cavity as well as extension to right ethmoidal and sphenoidal sinuses. No cranial or orbital involvement was seen. Histopathological examination revealed septate aspergillus hyphae along with large necrotic and inflammatory tissues. A diagnosis of aspergillosis was made and patient was given intravenous Amphotericin B 0.8/mg/kg/day. Under General Anesthesia, excision of complete right maxillary sinus as well as lateral wall of right nasal cavity was conducted and the patient was put on antifungal therapy for 6 weeks. References: Patil, P. M., & Bhadani, P. (2011). Extensive Maxillary Necrosis Following Tooth Extraction. Journal of Oral and Maxillofacial Surgery, 69(9), 2387-2391. doi:10.1016/j.joms.2010.11.018
Excellent presentation.This happens rarely after tooth extraction. What about follow up after giving amphotericin I/v.?
The patient was kept on antifungal therapy for 6 weeks with close monitoring of urea and Creatine. After six weeks serum galactomannan antigen test was conducted which turned out to be negative and the antifungal therapy was terminated.
