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A 42-year-old woman (above left) complained of a painless sore beneath her jaw. The sore had discharged pus intermittently duringthe previous four years, but numerous trials of antibiotic therapy had been ineffective. A 29-year-old woman (above right) noticed an occasionalserosanguineous 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 wasextracted, the discharge stopped, and the sore healed. In the other patient, radiographs showed a periapical radiolucency at the root of a maxillarypremolar, 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 dentalorigin. And because dental symptoms are often absent, diagnosis can be delayed for years.
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