11/18/2017
Case of the day: Patient with the chief complaint of having problems with the extraction site of left wisdom tooth #16. She believed there should be a problem causing bone loss and damage after the extraction was done one year ago. 4After taking history, her pain really had started about a month ago. After taking the panorex x-ray, both of the condyles showed signs of chronic pressure. Both of the SCM neck muscles were tender. Patient has a stressful job. Pain in throat and ringing ear. Tooth #14 with possible peri-apical lesion. Took a CB CT scan, both of the sinuses were filled with fluid. The air-fluid level is a sign of acute sinusitis, while if the molar tooth was causing the sinus problem, there should have been an obvious peri-apical lesion with an antrocele or a localized granulation tissue on the top of the tooth, inside the sinus. Interestingly, I even called the patient to ask her again before I type the case, she said that she has pain just on the left side and she does not have any flu signs or symptoms or allergies!
Diagnosis: Kind of a little bit of all of the above: Acute sinusitis accompanied by Myofacial pain and we will keep an eye on tooth #14.
Plan: antibiotics, nasal decongestant, vaporizer, warm towel on neck, stretches, meditation and follow up.
