Jaw Facial Swelling

Facial swelling of the maxilla is commonly associated with dental disease. A fracture of the maxillary 4th premolar with pulp exposure is the most common cause. Bacteria from the oral cavity will travel through the exposed pulp canal to the periapical tissues resulting in a maxillary sinus abscess.

Periodontal disease, tooth trauma, dentigerous cyst, or neoplasia are other causes of maxillary swellings. Therefore, dental radiographs and periodontal probing are essential tools in the detection and treatment of these patients.

Patients that present with a maxillary swelling should have an examination under anesthesia, periodontal probing, and radiographs of the premolars and molars of the affected side.
The roots of the patient’s 3rd premolar, 4th premolar, and 1st molar are the most commonly affected teeth.

This patient had no visible tooth abnormalities on his initial examination (second photo). Periodontal probing identified an 11mm periodontal pocket of the distal root of the 4 th premolar. Intra-oral radiographs confirmed a periapical lucency or tooth root abscess (blue arrow).

Treatment requires surgical extraction of the tooth. A mucoperiosteal flap is used to allow sectioning of the tooth. Then each root is approached as a “single rooted” tooth. High-speed burs are used to remove some bone and to position a luxator to fatigue the periodontal ligament during the extraction procedure.

A thorough curettage of the affected bone and lavage are performed. The periosteal tissue is transected to mobilize the flap and allow tension free closure with an absorbable suture such as Chromic Gut, Vicryl-rapid, or Monocryl.