Uncommon cause of non-healing extraction socket with oro-ant
Published in the International Journal of Advanced Research, a case of a non-healing upper first molar socket is described, which was initially thought to be an oro-antral fistula.

A 62-year-old male farmer reported with a complaint of blood stained mucous discharge from the left nostril on sneezing and foul breath with bad taste since 2 months. The patient had undergone extraction of upper left permanent first molar 2 months back at his local dentist’s office. He had discomfort in the region of the extraction socket. Soon after, expression of a yellowish foul smelling discharge followed from the socket and the patient also had heaviness of the left upper jaw around the same time.

He then reported to the dentist with his problems, who diagnosed it as an oro-antral fistula. He was then referred to the author’s institution for further management. The patient was a known hypertensive since 5 years under control with medication, apart from which his medical history was not contributory. There wasn’t any history of fever, headache, cough, allergic rhinitis or alteration in voice. He was normally built and without signs of malnutrition. Extra orally, his face was symmetric, with tenderness over the left malar region being the only abnormality.

On intraoral examination, left maxillary 1st Molar (26) and 2nd Molar (27) were missing with a non-healing socket of 26 with blood stained discharge from the opening of the defect. IOPA of 26 regions showed a breach in the continuity of floor of the maxillary sinus. The PNS view revealed a cloudy opacity of the left maxillary sinus. A diagnosis of chronic bacterial maxillary sinusitis secondary to oroantral fistula in relation to 26 was made.

Intra operatively on reflecting the mucoperiosteal flap, erosion of the anterior wall of the maxilla, with blood stained discharge from the opening was noticed. Through the opening, the maxillary sinus lining was enucleated in piecemeal, but the sinus contents and lining appeared unusual.

A brownish, friable mass was found in the left maxillary sinus with excessive bleeding. This, together with the necrotic debris, was completely removed using debridement and suctioning.

The histopathological diagnosis was chronic maxillary sinusitis with aspergilloma – Invasive Aspergillosis of Left Maxillary sinus. Due to the aggressive nature of the lesion the patient was referred to the department of internal medicine for further management with systemic anti-fungal therapy. The patient was then given Itraconazole 100mg, thrice daily for 3weeks. The symptoms of the patient resolved and the PNS view taken 2 weeks later had resolution of the Left Maxillary sinusitis.

Read more here: http://www.journalijar.com/uploads/2013-11-06_051657_41.pdf
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