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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

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.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

Feasibility of Facial Nerve Preservation in Locally Advanced Parotid Squamous Cell Carcinoma Following Extended Neoadjuvant Chemotherapy: A Case Report Janris Sitompul; I Gde Ardika Nuaba; I Dewa Gede Arta Eka Putra; I Wayan Sucipta; I Putu Santhi Dewantara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1554

Background: Primary squamous cell carcinoma (SCC) of the parotid gland is a rare, aggressive malignancy often requiring radical parotidectomy with facial nerve sacrifice, particularly in T4b stage disease. The utility of neoadjuvant chemotherapy (NACT) in downstaging these tumors to facilitate functional nerve preservation remains controversial and under-reported in the literature. Case presentation: A 58-year-old male presented with a fixed, rapidly enlarging left preauricular mass classified as cT4bN2M0 (Stage IVA). The tumor involved the sternocleidomastoid muscle and encased the external carotid artery. Following a multidisciplinary tumor board decision, the patient underwent an extended course of six cycles of Paclitaxel and Carboplatin. The tumor exhibited a partial clinical response and significant central necrosis on imaging. Subsequently, a total parotidectomy was performed. Despite intraoperative fragility and adherence to deep vascular structures, the main trunk and primary divisions of the facial nerve were anatomically and functionally preserved. Histopathology confirmed high-grade SCC with perineural invasion limited to the distal excised branches, achieving clear margins. The patient received 66 Gy of adjuvant radiotherapy. At the 18-month follow-up, the patient remains disease-free with House-Brackmann Grade I facial function. Conclusion: Long-term facial nerve preservation is feasible in selected cases of locally advanced parotid SCC using a multimodal approach. Extended NACT may induce tumor necrosis and facilitate dissection along the neuro-vascular interface, provided that perineural invasion does not involve the main nerve trunk.

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

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.

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