Is It Really an Atheroma? A Rare Presentation of Maxillary Apical Abscess on the Upper Nasolabial Fold Region

Abstract

An apical abscess is a dental abscess that occurs at the end of a root, caused by tooth decay which invades the pulp chamber of the tooth. This infection may spread to the adjacent area with clinical presentation of local abscess, facial cellulitis, suppurative osteomyelitis of the jaws, neck infection, or mediastinitis. They are mostly resulted from the mandibular teeth. We reported a rare case of maxillary apical abscess with the clinical presentation of an atheroma-like recurrent facial tumor over upper nasolabial fold region. A 72-year-old lady diagnosed of a recurrent facial atheroma after surgery twice was referred to us. The third time of tumor excision was performed with the result of poor wound healing. A continuous cutaneous draining sinus developed without any improvement. The pathological examination revealed granulomatous tissue with abscess formation. Tracing to the history, she didn't have any dental discomfort recently but a decayed right maxillary canine was noted in the physical examination. The radiography showed periapical radiolucency around the root. An apical abscess was impressed. After extraction of the tooth, the drainage sinus healed spontaneously. A maxillary apical abscess with the clinical presentation of an atheromalike facial tumor on upper nasolabial area was rare. It may be misdiagnosed and treated inappropriately. The surgeons should keep alert the possibility of a dental origin when facing to a chronic, unhealing facial wound after tumor excision.