抄録
A case of temporal abscess due to advanced phlegmon of cheek complicated with severe diabetes mellitus was diagnosed at our department. Diabetes was diagnosed in a 38-year old male at the age of 23 ; this patient had received therapy but later discontinued it.
He was slightly flushed and showed diffuse swelling from the area below the left mandible to the cheek caused by the 3rd molar of the left mandible. Mild rubefaction, heat sensation, pain and difficulty in opening his mouth were noted. Diffuse swelling, floridity and pain were focused on the molar region of the left mandible.
According to clinical examination performed during the initial consultation, the following results were obtained ; leukocyte count : 127×102/μl, blood sedimentation : 89mm/1h, CRP : 2+, blood sugar : 483mg/dl, urine sugar : > 1000mg/dl (4+), ketone body : 100mg/dl (3+), HbA1c : 11.9%, and HbA1 : 13.7%.
The patient was hospitalized and received ASPC intravenous drip infusion and he was placed on insulin therapy and a diabetic diet.
On the day after his admission, under local anesthesia, an intraoral incision was made for drainage. The drug sensitivity test performed on the 14th day after his admission showed a negative reaction to ASPC.There fore ASPC was replaced with FMOX. A left temporal abscess gradually formed and a drainage incision was made on the 18th day.
These therapeutic techniques failed to stabilize the blood sugar level and accelerated the local inflammatory symptoms. In order to improve these symptoms, a higher dose of insulin was administered. The causative tooth was extracted on the 21st day and anaerobic bacteria were detected on the 23rd day. PAPM/BP and FMOX were administered to extend the antimicrobial spectrum.
On the 26th day, formation of a temporal abscess was observed, so incisional drainage and removal of the necrotic tissues by incision were performed.
On the basis of a roentgenolography and a bone scintigraphy, a diagnosis of osteomyelitis of the left mandible was made. On the 61st day, under general anesthesia, the left mandible was scraped out after extraoral skin incision. From the 69th day on, the inflammatory symptoms improved and LAPC was orally administered.
After this surgery, insulin therapy was terminated because his blood sugar level dropped to under 200mg/dl.
He has been in satisfactory condition for seven months postoperatively.
