Facial Lesion in a Child

Case presented by Dr Munqithe M Jabir, Addiwaniya, Iraq who writes:

"Can I please have your opinion about this problematic case.

The patient is a female child with a swelling on her left cheek for the past three months.  It discharges pus through many openings (carbuncle-like!!).  There has been no change although many courses of different antibiotics, but, recently it has responded slowly to Rifampicin 150mg twice daily and Clarithromycin 250 mg twice daily.  Complete blood picture and ESR are normal."

Here is a Video. 

References:

1. Embedded toothbrush foreign body in cheek - report of an unusual case.

Sathish R, Suhas S, Gayathri G, Ravikumar G, Chandrashekar L, Omprakash TL.  Eur Arch Paediatr Dent. 2011 Oct;12(5):272-4.

Source: Oral and Maxillofacial Surgery, Sri Siddhartha Dental College, India. drsathish75@gmail.com [This was suggested by Brian Maurer's comment]

2. Pediatr Dermatol. 2010 Jul-Aug;27(4):410-1.

Cutaneous facial sinus tract of dental origin.Mardones F, Oroz J, Muñoz C, Alfaro C, Soto R.

Dermatology Department, Hospital Clínico, Universidad de Chile, Santiago, Chile. fmardonesv@yahoo.com

Abstract: Cutaneous sinus tract on the head and neck area in a child may originate from dental disease. A high degree of clinical suspicion and complementary tests are often needed, as the diagnosis is usually not straight forward. Anatomical correlation is also useful in tracing the affected tooth or teeth. We present the case of a boy with a facial sinus tract that originated from periapical abscesses of maxillary molars.