A 42-year-old woman (above left) complained of a painless sore beneath her jaw. The sore had discharged pus intermittently during the previous four years, but numerous trials of antibiotic therapy had been ineffective. A 29-year-old woman (above right) noticed an occasional serosanguineous discharge from a red spot near the angle of her jaw. The drainage was painless and had been present for six months.
Dental radiographs in the first patient (left image) showed a periapical abscess of a mandibular molar. After the tooth was extracted, the discharge stopped, and the sore healed. In the other patient, radiographs showed a periapical radiolucency at the root of a maxillary premolar, suggesting pulpal necrosis. Conventional endodontic therapy saved the tooth and cured the discharge.
These two cases illustrate an important clinical point: Most chronically draining sinuses of the face or neck have a dental origin. And because dental symptoms are often absent, diagnosis can be delayed for years.
"This book is available in full color in three different formats, published by Rice University Press. It presents a series of interesting medical cases and the eventual diagnosis of each one. "