Forum for Clinical and Surgical Oral Pathology

Case BBOPF 04-7

Dr. Bryan Withaker (Fayetteville, Arkansas. USA) invites your comments for this case. Please send your comments in the window located below the electronic image. This case will be posted from August 10 to August 20, 2004. A summary of the responses will be available in BBOP.

Clinical History

35 YOWF with a history of chronic sinusitis, hiatal hernia, dental anxiety, sulfa drug allergy, demerol allergy and a car accident recently that apparently didn't traumatize the teeth.

Medications: Cephalexin - Syntest DS - Welbutrin - Allegra - Skelaxin

Dental

? history of trauma - # 9 "has been crooked for a long time" - "the area will drain into my nose sometimes" - Recent swelling above tooth #9 - swelling drained by oral surgeon - probe along #9 of 7mm - vitality tests normal by general dentist - sent for endodontic consult - tested vital to cold and electric pulp tests - no restorations or caries - root canal space normal in size and form - apex appears normal - one film suggests a periapical radioluceny but it is indistinct and not seen on other films - a small radiolucent area interproximal to #8,9 can be seen - the incisive papilla appears normal but the interdental papilla #8,9 is elongated apparently due to crowding - periodontal probing was normal - #9 was slightly mobile

Due to the history of drainage into the nose, she was sent to an ENT for a consult, this was apparently negative and he felt the problem was dental (I believe he did an MRI, however and we don't have the results yet) - we had her back and performed a test cavity without local anesthesia - she certainly felt the bur prior to opening into dentin - the procedure was halted and a bonded resin placed - that is where we stand at the moment - I was hoping someone might be able to make some suggestions.

Possible nasopalatine duct cyst that becomes secondarily infected? The site of the surgeon's incision was inferior to where a nasolabial cyst would present. Other thoughts?

Images

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).