Post Traumatic Foreign Body Implantation of Mandible Masquerading as Dentoalveolar Abscess-A Case Report

Case Report

Austin J Dent. 2016; 3(2): 1033.

Post Traumatic Foreign Body Implantation of Mandible Masquerading as Dentoalveolar Abscess-A Case Report

Deepa JP*, Dheeraj S, Gagan P, Aravinda K, Avani D and Rajesh G

Department of Oral Medicine, Diagnosis and Radiology, Swami Devi Dyal Dental College and Hospital, India

*Corresponding author: Deepa Jatti Patil, Department of Oral Medicine, Diagnosis and Radiology, Swami Devi Dyal Dental College and Hospital, Golpura, Panchkula, Haryana, India

Received: March 12, 2016; Accepted: May 23, 2016; Published: May 25, 2016

Abstract

Background: Foreign body implantation in the oral cavity can be exogenous and endogenous in origin. After trauma they can instigate an array of biological reactions such as inflammation, infections, allergic reactions, toxic events and tissue alterations. If the foreign body is not removed it can cause delayed healing with superimposed infections. Such foreign bodies can be missed during examination.

Case Details: A 35 year old male patient, reported with a chief complaint of pain, swelling and recurrent pus discharge in the lower right back region of the jaw since 2 months. He had a history of trauma six months back and was treated for the same by a local surgeon. With the help of meticulous history, clinical examination and imaging techniques presence of foreign body was detected which caused persistent infection.

Conclusion: A careful history, clinical examination and imaging techniques should be considered for patients with any traumatic injuries. Intraosseous and extraosseous foreign body implantation should be included in the differential diagnosis of the soft tissue masses, mainly in the presence of previous surgery or accidental trauma history.

Keywords: Foreign body implantation; Trauma; Stones; Dysesthesia; Radiographs

Introduction

The term foreign body reaction is used for the tissue response to extraneous materials that becomes implanted in or beneath dermis. Such reactions occur as a result of direct accidental penetration of the exogenous materials or due to iatrogenic cause, both inducing an inflammatory reaction [1]. Road Traffic Accident (RTA) is one of the common causes of exogenous implantation [2].

Foreign-bodies can penetrate soft tissues in connection with accidents through open wounds and lacerations [3]. The presence of a foreign-body impairs the healing of the tissues, inducing biological reactions like inflammation, infections, allergic reactions, toxic events and tissue alterations. Manuscripts on foreign-body reactions instigating from a traumatic Implantation with different objects, including fish bones, teeth and metallic material have been well documented in the literature [4,5].

This case report describes an unusual manifestation of foreign body implantation after trauma, which masqueraded as a dental infection. With the help of careful history, clinical examination and imaging techniques presence of foreign body was detected. On surgical exploration the foreign bodies were multiple stones which evoked an inflammatory reaction resulting in delayed healing and recurrent infection.

Case Presentation

A 35 year old male patient reported to the Department of Oral Medicine & Radiology with a chief complaint of pain and swelling in the lower right back region of the jaw since 2 months. The patient was apparently normal 6 months back after which he met with an accident and suffered trauma to the right side of the lower jaw. He was treated by a local practioner, who placed sutures on the right angle of the mandible. Two months back he noticed pus discharge in the same region. Pain is sudden in onset, sharp and radiating to the ear of the same side. No sign of fever or dysphasia is present. He also complains of altered sensation of the lower lip since 2-3 months which affected his daily activities. His medical history was non contributory. On extraoral examination, there was dysesthesia of the right side of the lower lip. On intraoral examination a solitary, erythematous, well defined, oval swelling is seen extending from mesial surface of the 46 to the mesial surface of lower right second molar. It is non tender and hard in consistency. A draining sinus is also present in the buccal vestibule of 47 (Figure 1). Right sub mandibular lymph nodes were palpable, soft in consistency and mobile A provisional diagnosis of Dentoalveolar abscess secondary to trauma was given. Chronic osteomyelitis was considered under differential diagnosis. An Intra oral periapical radiograph (IOPA) with 47, 48, right lateral occlusal radiograph and panoramic radiograph was advised. IOPA radiograph revealed a well defined round radio-opacity with comparable radiodensity as enamel overlying the mesial root of 47 above the inferior alveolar canal. Right lateral lower occlusal radiograph revealed multiple irregular shaped radio-opacities along the inferior border of mandible on the periosteal surface around 46, 47 regions with no expansion of the cortical plate (Figure 2). Panoramic radiograph also revealed multiple well defined radio-opacity overlying 47 and multiple ill defined radio-opacities along the inferior border of mandible (Figure 3). After radiological investigations, a differential diagnosis of chronic osteomyelitis, foreign body implantation, dystrophic calcification and soft tissue radio-opacities was given. The differential diagnosis is discussed in (Table 1). Pus was aspirated and sent for culture and sensitivity. It showed the presence of staphylococcus albus micro-organism. Due to the previous history of trauma and the radiographic presentation a final diagnosis of dentoalveolar abscess secondary to foreign body implantation was given.