[Oradlist] 11 years old male

[Malcolm Coombs]

Dear Ebtihal,

 

I feel we are looking a post operative haematoma which may be the result of damage to the Posterior superior alveolar blood vessels if the patient had the treatment carried out under a local anaesthetic (LA). 

Bleeding into the pterygoid space can cause swelling in and around the salivary glands and the natural drainage is downwards. A haematoma can take several weeks to return to normal size if it has not been drained effectively in thwe first place.

Over the years I have seen similar conditions following extraction of posterior teeth under LA in adults never as young as your patient.

I would be interested to hear how your patient progresses.

 

Malcolm I Coombs

Head of Oral Surgery and Diagnostic Imaging.

Sydney Dental Hospital

Faculty of Dentistry

Univesity of Sydney

Australia.

 


Date: Sun, 22 Aug 2010 13:12:36 +0300
From: ebtihalh at gmail.com
To: oradlist at lists.ucla.edu
Subject: [Oradlist] 11 years old male


Hello 
I have a very interesting case today and i hope you can help me with your valuable experience
An 11 years old boy had his 74 and 75 teeth extracted by a dentist, the next day he showed to clinic with non-painful swelling of his left parotid and left submandibular glands, the swelling was non-fluctuant rubbery and aspiration reveald blood, patient was not febrile and saliva flow was normal ,he was admitted to the hospital and flgyle I.V was given to him. today it is the tenth day and there is no improovemnt and the size of the swelling is the same, CT with contrast was requested for him , i have attached selected axial sections of the CT with contrast and it shows swelling of left parotid and left submandiblar gland, the internal structure of the parotid gland shows heterogeneous density while the submandibilar gland mostly had low density within the internal structure of the gland.
My opinion is that the patient had a kind of obstruction after the extraction that accumulate saliva within the glands, however the aspiration revealed blood and the saliva flow is normal , i don't think it is inflammatory in origin since the patient is not febrile.any suggestions ? 



-- 
Ebtihal H. Zain Alabdeen, BDS, Msc
Oral and Maxillofacial Radiology
Ministry of Health
Riyadh, Saudi Arabia


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