33 yr old male with c/o pus oozing out from his upp. left third molar region

February 15, 2022

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CHIEF COMPLAIN: c/o pus oozing out from his upper. left third molar region

PATIENT HISTORY: A 33yr old man visited our hospital on 10/02/22 with c/o pus oozing out from his upper. left third molar region. He is an auto driver by profession. When he was 1.5 yrs old he hit his left eye with a sharp object while playing with a sharp cutter and severely damaged his eye. His parents took him to clinician but he needed Sx which was not done due to financial problem. After that while staying in Bangalore he visited many hospital but again Sx was recommended which he didn't want. Now he has completely lost his vision on left eye for the past 6 - 7 years. He left studies in 2004 - 05 came to Bangalore to find job, worked as a construction worker making steel frames for building. Went back home after 3 months. Again returned to Bangalore for the same work. This time stayed for 1 - 1.5 years. During his stay i.e 2008 - 09 started alcohol consumption(20 ml/day) due to peer-pressure. Returned home after staying in Bangalore for 1 - 1.5 yrs. After that takes alc. once/month 20 ml or only during some occasion. Returned to Bangalore in 2010. This time started having tobacco(due to peer-pressure) 4 - 5 times/ day around 2 gms still continuing. From 2009 - 13 got money along with peer-pressure, so used to have cigarettes( 3 - 4 cigarettes/day ). After 2013 had only 1 cigarette/ 4 months. In 2013 went back home, started farming potatoes, spices, rice. From 2016 till date drives auto in Mathabhanga( W.B ). From the year 2008 - 2016 c/o periodic cough mostly dry which was seasonal i.e one episode in Summer, one in Winter and used to last for 10 - 15 days which would go way after having cough syrup. From 2016 - 19 started having alc. again 50ml 2 days/wk due to peer-pressure. In 2015 had fight with cousin over lottery busines, was hit in the left jaw where pain persisted for 2 - 3 days. After that pain resolved on its own. Around Dec 2021 pt c/o pain, swelling and little cream coloured pus from the upp. left side molar tooth(NOTE: On upper jaw his wisdom tooth are missing from both side i.e never arise) for which he visited a Dentist, took some tablets and pain and swelling resolved. 5 days later again pain and swelling started from the same region, visited Dr., started taking medications, but on the 4 th day on the course lot of pus came out after which his pain and swelling reduced significantly. He used to block his nostrils and create pressure inside to drain pus ?from the maxillary sinus. Once while doing that noticed little blood stain from his nostrils. On 01/01/22 went to dentist who cleaned his teeth after which pus amount decreased a bit. On 04/01/22 Physician gave him medications and ordered OPG and CBCT. Patient could not do the tests that time visited another Physician on 16/01/22 who gave him Clavam 625 mg( 1 tab BD for 5 days ), Tab. Metrogyl 200 mg ( 1 tab for 5 days ), Tab. Voveran D ( 1 tab BD for 5 days ). On 17/01/22 pain increased very much. on 18/01/22 pain decreased. After OPG, CBCT reports on 22/01/22 Physician gave him Tab. Taxim O ( 1 tab BD for 5 days ) which he didn't take. On 05/02/22 for the first time reddish pus came out. Seeing that he took Taxim O on 7th and 8th. When he came here pain has reduced a lot, but pus is there.

CBCT report.

OPG report

RADIOGRAPHIC PROVISIONAL DIAGNOSIS:

Radiographic features can be suggestive of left maxillary sinusitis with ?osteomyelitic changes in the left floor and the medial and lateral borders of the maxillary sinus.
D/D: Suspected aggressive lesion?
Oro antral communication distal to #28 region
Pulpal calcification in the teeth of the Lf posterior maxilla and posterior mandibular region.