Left gingival swelling for three months. Swelling of the left cheek for two weeks. Bad mouth odour.
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The roots of the left maxillary second premolar tooth are noted surrounded by focal hypodensity showing defective overlying buccal cortex. Overlying soft tissue densities involving the related gingiva averaging 1.5 cm with extension towards the left side of the oral mucosal space and the superior oral sulcus. It also extends to the left buccinator muscle and superficial to the anterior bony wall of the left maxillary sinus implicating the related facial muscles with resultant prominent soft tissues of the left cheek.
The left maxillary sinus showed mucosal thickening involving the alveolar recess.
Bilaterally enlarged cervical lymph nodes belong to near all groups, mostly reactive.
These features and the clinical presentation are suggestive of periapical abscess surrounding the root of the left second maxillary premolar tooth with extension of the inflammatory process to surrounding soft tissue structures. It is usually secondary to dental caries and may need drainage for treatment. Complications include sinusitis, osteomyelitis, meningitis and Ludwig angina.