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Putu Dian Ariyanti Putri
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Deep Neck Abscess with Concurrent Orbital and Subgaleal Extension Secondary to Odontogenic Infection: A Case Report Pande Agus Parta Prananda; Putu Dian Ariyanti Putri; I Made Wiranadha; I Dewa Gede Arta Eka Putra; Eka Putra Setiawan; Sari Wulan Dwi Sutanegara
Archives of The Medicine and Case Reports Vol. 6 No. 3 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i3.744

Abstract

Deep neck infections (DNIs) originating from odontogenic sources are common, but extensive spread involving concurrent orbital and subgaleal spaces is rare. DNIs can lead to life-threatening complications, particularly in patients with comorbidities like diabetes mellitus (DM) and chronic kidney disease (CKD), which impair immune function. This report details a complex case of DNI with unusual superior extension. A 44-year-old male with poorly controlled type 2 DM and CKD presented with a two-day history of rapidly progressing left facial, submandibular, parotid, and orbital swelling, associated with fever, trismus, and severe pain, originating from a carious mandibular molar. CT imaging confirmed an extensive abscess involving the left masticator, submandibular, sublingual, parotid, and parapharyngeal spaces, with contiguous spread to the left preseptal orbital space and the fronto-temporo-parietal subgaleal space. Multidisciplinary management involved urgent surgical drainage of the submandibular and subgaleal abscesses, odontectomy of the offending molar, broad-spectrum intravenous antibiotics (Citrobacter amalonaticus and Proteus hauseri identified on culture), intensive glycemic control, hemodialysis, and supportive care. In conclusion, this case highlights the potential for aggressive craniofacial spread of odontogenic DNIs, particularly in immunocompromised individuals. Concurrent orbital and subgaleal extension represents a rare and serious complication. Prompt diagnosis with imaging, aggressive multidisciplinary surgical and medical management, including addressing underlying comorbidities, were crucial for a successful outcome.
Palatal Abscess of Odontogenic Origin Causing Dyspnea in an Elderly Patient: A Case Report and Critical Review of Management Strategies I Dewa Gede Arta Eka Putra; Putu Dian Ariyanti Putri; Ketut Tadeus Max Nurcahya Pinatih; Made Gede Krisna Rendra Kawisana
Archives of The Medicine and Case Reports Vol. 7 No. 1 (2026): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v7i1.842

Abstract

Odontogenic infections are prevalent clinical entities, typically presenting as localized pathologies within the alveolar process. However, a palatal abscess—a specific manifestation arising from the spread of infection through the palatal cortical plate of maxillary teeth—rarely escalates to cause life-threatening airway compromise. This report details an exceptional case of a palatal abscess causing significant dyspnea in an elderly patient, challenging the conventional understanding of the hard palate as a robust anatomical barrier preventing deep space extension. A 68-year-old female presented to the emergency department on October 1st, 2022, with a five-day history of progressively enlarging palatal swelling, dysphagia, and dyspnea. Clinical examination revealed a massive, fluctuant mass extending from the hard to the soft palate, obstructing the oropharyngeal inlet. Despite a leukocyte count at the upper limit of normal and an afebrile status—indicative of geriatric immunosenescence—the patient exhibited objective tachypnea (24 breaths/min). Diagnosis was confirmed via needle aspiration. Management involved immediate airway stabilization, broad-spectrum antibiotics (Ceftriaxone and Metronidazole), and corticosteroids. On October 3rd, 2022, the patient underwent incision and drainage under general anesthesia, yielding 15cc of purulent material. The source was identified as carious residual roots of the maxillary right second molar (FDI #17). Post-operative recovery was rapid, with discharge on October 6th, 2022. In conclusion, this case underscores that palatal abscesses can evolve into critical airway emergencies, particularly in geriatric patients with diminished physiological reserves and blunted immune responses. Prompt recognition, aggressive multidisciplinary management, and definitive dental treatment are paramount to preventing mortality.
Co-Authors Eka Putra Setiawan I Dewa Gede Arta Eka Putra I Made Wiranadha Ketut Tadeus Max Nurcahya Pinatih Made Gede Krisna Rendra Kawisana Pande Agus Parta Prananda Sari Wulan Dwi Sutanegara