Surgical management of severe odontogenic facial cellulitis after a tooth extraction in a pregnant patient

Abstract

Odontogenic facial cellulitis is a frequent infection and the most serious emergency that can occur in dental practice. A simple surgical procedure, and sometimes wrongly underestimated, such as a tooth extraction, can be the cause of this infection. Its treatment consists of antimicrobial therapy and immediate surgical drainage is sometimes necessary, due to the severity of the clinical manifestations and the patient's conditions. We present the case of a 22-year-old pregnant woman, who was admitted to the department of oral and maxillofacial surgery of the "Enrique Cabrera" National Hospital, with acute manifestations of toxinfection, fever of 39 oC, general malaise, drowsiness, severe pain in the affected area, diffuse edema of the entire lateral region of the middle third of the face, the left zygomatic arch and the entire temporal region, with severe trismus that made it impossible to feed herself. She stated that five days before she had an extraction of the left upper second molar. After being treated with antimicrobial therapy with metronidazole and ceftriaxone, and since there was no improvement in her serious condition, it was decided to perform preventive debridement surgery to drain the purulent collection and avoid lethal complications. Subsequently, antibiotic therapy and washes with hydrogen peroxide were continued. Immediate remission of the serious symptoms was observed after surgery. The patient recovered, with a good health status during her pregnancy.