PMC9296300_01
(a-d) Patient photos at ER presentation 13/02/2021: front (a); right side (b); inferior (c); open mouth (d). Evident swelling of the medial and inferior third of the right side of the face (a, b). Trismus, oedema of the tongue and mouth floor (d).
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On ER physical examination, the patient presented a voluminous right half-face abscess, inability to speak correctly due to trismus, and oedema of the tongue and mouth floor (Figure 1).
Initial orthopantomography (OPG) X-ray 13/02/2021: partial edentulism; outcomes of conservative and orthodontic therapy, prosthetic rehabilitation.
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Sars-CoV2 swab (negative), orthopantomography (OPG) X-ray (Figure 2), computed tomographies (CT) of the head-neck (Figures 3 and 4), and chest (Figure 5) were performed. Skull CT underlined the presence of gas bubbles in both the cavernous sinuses, possible odontogenic focus on tooth 4.7, part of a prosthetic bridge (4.7-4.5); neck CT was positive for huge phlegmon and gas bubbles affecting the right half of the face and platysma, the right parotid gland posteriorly, extending up to the contralateral parotid capsule and sternocleidomastoid muscle medially and the thyroid space inferiorly; chest CT showed no pathological findings.
(a, b) Initial computed tomography (CT) of the head: frontal plane (a); transverse plane (b). Presence of gas bubbles in both cavernous sinuses, the right half of the face and buccal floor (red arrows) (13/02/2021).
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Sars-CoV2 swab (negative), orthopantomography (OPG) X-ray (Figure 2), computed tomographies (CT) of the head-neck (Figures 3 and 4), and chest (Figure 5) were performed. Skull CT underlined the presence of gas bubbles in both the cavernous sinuses, possible odontogenic focus on tooth 4.7, part of a prosthetic bridge (4.7-4.5); neck CT was positive for huge phlegmon and gas bubbles affecting the right half of the face and platysma, the right parotid gland posteriorly, extending up to the contralateral parotid capsule and sternocleidomastoid muscle medially and the thyroid space inferiorly; chest CT showed no pathological findings.
(a-d) Initial CT of the neck (transverse plane) highlighting the presence of gas bubbles (red arrows): at the right parotid gland posteriorly (a); oral floor extending up to the contralateral parotid capsule (b); sternocleidomastoid muscle medially and the thyroid space inferiorly (c); at the right parotid gland in a different cutting plane height (d) (13/02/2021).
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Sars-CoV2 swab (negative), orthopantomography (OPG) X-ray (Figure 2), computed tomographies (CT) of the head-neck (Figures 3 and 4), and chest (Figure 5) were performed. Skull CT underlined the presence of gas bubbles in both the cavernous sinuses, possible odontogenic focus on tooth 4.7, part of a prosthetic bridge (4.7-4.5); neck CT was positive for huge phlegmon and gas bubbles affecting the right half of the face and platysma, the right parotid gland posteriorly, extending up to the contralateral parotid capsule and sternocleidomastoid muscle medially and the thyroid space inferiorly; chest CT showed no pathological findings.
Initial CT of the chest.
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Sars-CoV2 swab (negative), orthopantomography (OPG) X-ray (Figure 2), computed tomographies (CT) of the head-neck (Figures 3 and 4), and chest (Figure 5) were performed. Skull CT underlined the presence of gas bubbles in both the cavernous sinuses, possible odontogenic focus on tooth 4.7, part of a prosthetic bridge (4.7-4.5); neck CT was positive for huge phlegmon and gas bubbles affecting the right half of the face and platysma, the right parotid gland posteriorly, extending up to the contralateral parotid capsule and sternocleidomastoid muscle medially and the thyroid space inferiorly; chest CT showed no pathological findings.
(a, b) Emergency surgery at ER: surgical procedure preparation (a); laterocervical abscess drainage (b).
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The patient also underwent a surgical tracheostomy, according to the previous optic fibre video evaluation, in order to secure the airways and ensure proper ventilation (Figure 6).
(a-f) Extraction of 1.7 (a, b); extraction of 4.7 plus pontic (c, d); extracted 1.7 (e) and 4.7 (f).
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The patient proceeded to surgery (Figure 7).
Final CT neck and chest 01/03/2021.
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Patient discharge took place approximately 1 month after performing neck and chest CTs (Table 2 and Figure 8).
(a-d) Final patient photos: right side (a); front (b); left side (c); neck scar detail (d). Presence of scarring outcomes on the neck; absence of swelling of the face and neck.
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Check-up 3 months after discharge revealed no externally visible swelling (Figure 9) and a good intraoral tissues healing (Figure 10).
(a, b) Final intraoral photos: after extraction site of 4.7 (a); after extraction site of 1.7 (b). Good tissue healing on the extraction sites of 4.7 (blue arrow) and 1.7 (green arrow).
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Check-up 3 months after discharge revealed no externally visible swelling (Figure 9) and a good intraoral tissues healing (Figure 10).
(a, b) Final OPG X-ray (17/06/2021): no relevant findings on the extraction sites (magnification (b)).
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Control OPG (Figure 11); CTs of head-neck and chest were requested and checked.