Purulent Collection Research Articles

Peritonitis Caused by Morganella morganii After Elective Cesarean Section

Morganella morganii belongs to the tribe Proteeae of the Enterobacteriaceae family. This species is considered as an unusual opportunistic pathogen that mainly causes post-operative wound and urinary tract infections. In this case we report a 33 year old multigravid woman presented to the emergency with diffuse lower abdominal pain. She was on her postoperative sixth day after an elective cesarean. Physical examination showed signs of acute abdomen and laboratory findings were consistent with infection. An emergency laparatomy revealed intraabdominal purulent fluis collection and fibrin deposits on organs. Microbiologic culture resulted in M. morganii and appropriate antibiotherapy was applied. The patient was discharged with no further complications. In conclusion, M. morganii is a rare cause of cesarean section related peritonitis and our patient may be the first case of M. morganii peritonitis and the first of monobacterial infection with that organism.

Abscesso hepático piogênico por Pseudomonas aeruginosa em pré-escolar

Pyogenic hepatic abscess is a purulent collection secondary to bacterial infection in the hepatic parenchyma. Is relatively rare in general population, around 1.1 to 2.3/100.000 inhabitant, with mortality between 5.6-80%. In this study, we report the case of a preschool, male, with fourteen days of fever, abdominal distention, pallor, Torres-Homem sign, periumbilical hypertimpanism and hepatomegaly. He arrived with leukocytosis/neutrophilia, high reactive-C protein, normochromic/normocitic anemia, increased liver and canalicular enzymes, in addition to alteration of coagulation tests. Ultrasonography and abdominal tomography showed heterogeneous collections of irregular contours and inaccurate limits in segments IV, V, VII and VIII. Gallbladder of thickened walls with hyperechogenic image measuring 0.8cm. The initial treatment consisted of the association of ampicillin and sulbactam associated with metronidazol and transcutaneous drainage of the abscess guided by ultrasonography. With the positive culture of the abscess material for Pseudomonas aeruginosa, ciprofloxacin began and the performance of weekly abdominal ultrasound. He was discharged after ultrasonography of abdomen without abscesses. The triad of pyogenic hepatic abscess encompasses abdominal pain, intermittent fever and hepatomegaly. They are usually associated with predisposing factors from immunosuppression to biliary pathway pathologies and neoplasms. Percutaneous drainage guided by CT or US is currently first-line treatment. Even though it is rare, HA should be among the differential diagnosis options of abdominal pain and intermittent fever.

Nasal Septal Abscess Complicating Acute Sinusitis in an 8-Year-Old Child: A Case Report

Introduction: Nasal septal abscess (NSA) in the pediatric population is an uncommon condition, but it can cause devastating complications (such as potentially life-threatening intracranial infections and cosmetic nasal deformity). The objective of this study is to report a case of an pediatric patient presenting with NSA in association with frontal-ethmoid acute sinusitis and intracranial abscess. Method and Results: In this study, we report a case of an 8-year-old patient who progressed from spontaneous nasal septal abscess to sinusitis (maxillary, frontal and ethmoidal), cosmetic nasal deformity (destruction of septal cartilage) and intracranial complication. The purulent collection necessitated urgent surgical drainage and adequate medical treatment. Conclusion: Nasal septal abscess in children is a rare condition that necessitates early appropriate drainage in order to prevent severe life-threatening complications. Furthermore, in the growing child, in case of total destruction of the cartilaginous septum, immediate reconstruction with autologous cartilage graft is essential for normal development of the nose and maxilla.

Unusual complications of a common disease in COVID times: a case series

Acute appendicitis is the most common abdominal surgical emergency worldwide. 20-30% of cases of appendicitis can complicate which is defined as perforation, purulent peritoneal collection, abscess formation and generalized peritonitis. The risk of perforated appendicitis increases when appropriate treatment for acute appendicitis is delayed. There has been an avoidance of both urgent or emergency and routine medical care because of Coronavirus disease 2019 (COVID-19) concerns all over the world. In our study, the delayed presentation of the patients with acute appendicitis to the hospital prevented appropriate management leading to a much more morbid disease course. Increasing accessibility of medical and telehealth services might help prevent delay of needed care. Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay.

Dilute initial dentofacial abscess of buccal space: a technical note

The treatment of the dentofacial abscess was always surgical because the evacuation of the purulent collection and removal of the cause are mandatory. Large abscesses, especially those that reach the submandibular space, require laboratory and imaging exams, but small abscesses restricted to the buccal space can be successfully treated by diluting the purulent collection with saline solution using needle and syringe.

Comparative analysis of bacterial content, levels of lipopolysaccharides and lipoteichoic acid in symptomatic and asymptomatic endodontic infections at different stages of endodontic treatment.

This study aimed to detect the presence of specific bacteria and to evaluate the levels of lipopolysaccharides (LPS) and lipoteichoic acid (LTA) in symptomatic necrotic root canals associated with acute apical abscess (symptomatic group - GI). It also aimed to compare the findings with those presented by asymptomatic necrotic root canals (asymptomatic group - GII) in the different stages of the endodontic treatment. Microbiological samples were collected from 20 root canals, including purulent collection from acute apical abscesses, before and after chemo-mechanical preparation (CMP) preparation (CMP) with chlorhexidine gel 2% and after 30days of intracanal medication (ICM) with (Ca[OH]2) + chlorhexidine. The culture method was used to evaluate the efficacy of CMP and ICM. Nested PCR was used to detect the presence of 17 specific bacteria. Levels of LPS were measured by using limulus amebocyte lysate, whereas enzyme-linked immunosorbent assay was used for the quantification of LTA. CMP was effective in reducing the microbial load in both groups (P < 0.05). LPS levels were higher in GI than in GII (P < 0.05). There was a significant reduction in the LPS levels after CMP and ICM (P < 0.05) in GI and GII. LTA levels were significantly reduced in GI after ICM and in GII after CMP and ICM (both P < 0.05). Fusobacterium nucleatum and Enterococcus faecalis were frequently identified in both groups, alone or in combination with each other. Different species were detected in all stages of the endodontic treatment. CMP was able to reduce bacterial content and the levels of LPS, but not of LTA in the symptomatic group. High levels of LPS were correlated with spontaneous pain and pain to percussion in the symptomatic group. This clinical study showed that chemo-mechanical preparation was able to reduce bacterial load and levels of LPS, but not of LTA in the symptomatic group. Elevated levels of LPS were correlated with the presence of symptomatology.

Uterine health and fertility of timed AI postpartum Nelore beef cows raised in the Amazon biome

This study evaluated the effect of uterine health on the fertility of postpartum beef cows. Multiparous lactating Nelore cows (Bos indicus; n = 155) were subjected to a timed artificial insemination (TAI) protocol. Cows were included in a progesterone-estradiol based TAI protocol. On Day 0, before the beginning of the protocol, cows were subjected to evaluation of purulent vaginal discharge (PVD) and collection of uterine tissue using the cytobrush technique. Slides for polymorphonuclear (PMN) cells counting were prepared before the same cytobrush was used for RNA extraction and analysis of IL-1β, IL-6, IL-8, TNFα, GAPDH, and βactin gene transcription. Cows were separated into 4 categories according to the proportion of PMN and PVD: 1) Healthy (HE; n = 87), cows with ≤ 4.75% PMN and PVD of 0; 2) Positive Purulent Vaginal Discharge (PVD+; n = 24), cows with ≤ 4.75% PMN and PVD ≥ 1; 3) Subclinical Endometritis (SCE; n = 29), cows with > 4.75% PMN and PVD of 0, and; 4) Subclinical Endometritis + PVD+ (SCEP; n = 15), cows with > 4.75% PMN and PVD ≥ 1. Cows in the HE group had a greater (P < 0.05) pregnancy per AI (P/IA) than cows in SCE and SCEP groups. However, P/AI in cows from the PVD+ group was not different in comparison to HE and SCE groups (P > 0.05). Cows from the SCE and SCEP groups had a higher (P < 0.001) proportion of PMN cells in the uterus than HE and PVD+ groups. Relative transcription of IL-6 and TNFα did not change among groups (P > 0.05). In contrast, transcription of IL-8 was greater (P = 0.02) in SCEP than HE and SCE groups. The relative transcription IL-1β was greater (P < 0.05) in SCEP than in PVD+, but the cows in the HE and SCE groups were not different from the other groups (P = 0.08). Our results demonstrate that postpartum beef cows, raised in the Amazon biome, with a higher proportion of PMN cells have lower fertility. Moreover, ~ 40% of the postpartum cows included in TAI programs early postpartum had suboptimal uterine conditions (subclinical endometritis, purulent vaginal discharge, or both).

Management of an implant projected into the maxillary sinus associated with chronic sinusitis: A case report

An x-ray examination allowed the implant to be visualized and the amount of bone to be assessed at the site of the implant placement. Maxillary implants may have close relationships with the maxillary sinus. A preliminary X-ray examination of the implant site was used to assess the quality and quantity of bone and to assess the proximity of the sinuses. The authors report the extraction of a dental implant projected into the left maxillary sinus, associated with chronic sinusitis in a 65-year-old patient who did not previously receive sinus lift. An orthopantogram was used to visualize the cylindrical implant in an upright position in a very prominent sinus. With the maxillary scanner, the implant was located with more precision in 3D, surrounded by a frame image representing the purulent collection. The extraction of the implant projected into the sinus by a simple technique under local anesthesia was decided. A control orthopaontogram showed the emptiness of the sinus cavity. The surgical suites were simple. Elimination of an enlarged crestal intra sinusal implant should be undertaken first-line in oral surgery as it is simple and less invasive. To prevent these incidents, short implants or sinus elevation technique are alternatives for prominent bone and/or sinus deficits visualized through 3D imaging. Keywords: Implant projection, Maxillary sinus, Chronic sinusitis.

Pedicled omental wrapping of ascending aortic graft following mediastinitis

A 51-year-old male patient post-Aortic valve replacement (#25 SJM) underwent redo supra-coronary ascending aorta replacement for ascending aortic aneurysm developed a peri-graft purulent collection 2 months later post surgery. He was successfully treated by debridement of infected tissues, antiseptic irrigation with povidone, and omental wrapping of graft. The patient was discharged after full course of antibiotics. Quick diagnosis with debridement, irrigation, and omental wrapping can be effective in the treatment of mediastinitis following graft replacement of the ascending aorta for preventing catastrophic complications

Endocranial Suppurations of Sinus Origin: Ratio of 3 Cases in Children at the Hospital in Mali

Introduction: Intracranial suppurations are neoformed purulent collections including, in decreasing order, cerebral abscesses, subdural empyemas and extradural empyemas. Otorhinolaryngologic infections are one of the main causes, especially in older children and adolescents. We report 3 clinical cases of endocranial suppurations treated at the Mali Hospital. Clinical Cases: 1) Observation 1. IK was a 14-year-old boy, who was hospitalized in our department for fever, headache and left hemiplegia. The emergency brain scan showed a right frontal and interhemispheric subdural empyema associated with multifocal sinusitis. Surgical drainage associated with ceftriaxone: 100 mg/Kg/d in direct intravenous (DI), metronidazol: 10 mg/Kgs/12hours in slow intravenous (SI) for 15 days, gentamycin: 3 mg/Kgs/d in SI for 3 days, paracetamol 15 mg/Kgs/6hours in SI, 10% glucose serum: 100 ml/Kg/d were given. The bacteriological analysis of the pus came back sterile. The postoperative period was calm. 2) Observation 2. This was a 14-year-old boy with a history of headaches who was admitted to our department for left hemiplegia. An emergency brain scan showed a right pre-suppurative encephalitis associated with a right fronto-ethmoidal and maxillary sinusitis. He was put on ceftriaxone 100 mg/kg/d in DI for 21 days, gentamycin: 3 mg/Kg/d in SI for 3 days; metronidazole: 10 mg/kg/12hours in SI for 21 days, paracetamol: 15 mg/kg/6hours in SI. After 3 weeks of medical treatment, a follow-up brain scan revealed an interhemispheric and right subdural empyema. Surgical drainage was associated with the triple antibiotic therapy initially instituted. The bacteriological analysis of the pus was sterile. The postoperative course was calm. 3) Observation 3. N.M was an 11-year-old boy, who was admitted with fever and left hemiplegia. An emergency brain scan revealed a right hemispheric subdural empyema associated with an intracerebral abscess and pansinusitis. Surgical drainage associated with ceftriaxone 100 mg/kg/d in DI for 15 days, gentamycin; 3 mg/kg/d in SI for 3 days, metronidazole: 10 mg/kg/12hours in SI for 15 days and paracetamol: 15 mg/kg/6hours in SI were instituted. Staphylococcus aureus was isolated in the pus of the abscess. The postoperative course was calm. Conclusion: Endocranial suppurations of sinus origin are serious and frequent infections in children in developing countries. Its diagnosis must be evoked in front of any hemiplegia associated with a fever or headache and confirmed by a cerebral scanner.

ILIOPSOAS ABSCESS: A CASE REPORT

Iliopsoas Abscess (IA) is a rare condition that predominantly affects young adults. It is a purulent collection that forms inside the iliopsoas muscle for several reasons. The primary form is due to hematogenous or lymphatic dissemination and the secondary form is the direct expansion of an infectious focus near the iliopsoas muscle. It is an insidious disease with a dragged clinical course, presenting with fever, thigh pain associated with abdominal and/or lower back pain, and there may be limitation of movements in the hip joint. The aim of this study is to demonstrate a case of IA in a 32-year-old female patient, admitted to the Palmas General Public Hospital (HGPP). After treatment, the patient evolved with symptomatic improvement and good clinical outcome.

Frequency of Cervicofacial Necrotizing Fasciitis Secondary to Odontogenic Abscess

Introduction: One of the complications of odontogenic abscess is cervicofacial necrotizing fasciitis; which is infrequent in the cervicofacial region. This disease usually occurs in immunosuppressed patients. Treatment is broad spectrum antibiotics and surgery. Material and Method: A research study was conducted with the following characteristics: retrospective, descriptive, cross-sectional and observational, for a year, in the maxillofacial surgery service, of specialty hospital: “Dr. Antonio Fraga Mouret”, national medical center“ La Raza ” (IMSS), Mexico city; all patients (six) diagnosed with necrotizing cervicofacial fasciitis secondary to Odontogenic abscess, older than 18 years were included. The protocol consisted of taking a biopsy, antibiotic, culture with an antibiogram and surgical management. Data were collected to estimate the frequency of this pathology in the maxillofacial surgery service. Results: In one year, 6 patients with a diagnosis of necrotizing cervicofacial fasciitis secondary to odontogenic abscess were treated. No significant differences were found with respect to gender, the mean age was 69.16 years, (86; minimum 40). The mean number of affected aponeurotic spaces was 6.5 (maximum: 14; minimum: 2); the most affected side was the right. The most frequent aponeurotic spaces were: the facial (in turn, more were reported in the submandibular followed by submental and genian aponeurotic space) and one third the cervical. Surgical management was: cannulation and drainage of persistent abscess or purulent collection in four patients, surgical lavage was performed in all, 3 patients required more than 4 surgical washes. Debridement was performed in all patients. Discussion: The importance of this study is to show and report the frequency with which necrotizing cervicofacial fasciitis appears secondary to odontogenic abscess, to continue with the control and report in maxillofacial surgery, as well as improvements and proposals for a better management of patients who are diagnosed with this disease.

Pott’s Puffy Tumor with Intracranial Extension in a Minimally Symptomatic Adolescent

Pott’s puffy tumor is a non-neoplastic, Otolaryngological emergency. It is regarded as a rare clinical condition in the post-antibiotic era and a high index of suspicion is required for its diagnosis. The aetiology is multifactorial and includes sinusitis, infections, trauma, surgery, malignancy, substance abuse as well as contiguous spread along neurovascular bundles. These result in osteomyelitis and subperiosteal abscess formation within the frontal bone. Intracranial involvement can also occur and lead to serious complications. This is the case report of a 12-year old female who developed intermittent forehead swelling, headaches and pyrexia over a 2-week period. Radiological imaging identified changes consistent with a Pott’s puffy tumor complicated by an intracranial abscess. A combined open and endoscopic endonasal approach was used to drain the purulent collections and the patient was placed on antibiotics for a total of six weeks. The management of Pott’s puffy tumor will then be discussed.

Comparison of Electrocautery Versus Ultrasonic Shears in Laparoscopic Nephrectomy: a Pilot Randomized Controlled Trial

Novel energy devices such as ultrasonic shears (US) are widely used in laparoscopic surgery due to convenience and outcomes. However, these are expensive and add to the procedure cost. Electrocautery (EC) can often provide similar surgical outcomes and existing literature in unclear on the benefits of one over the other. We conducted a randomized trial between US and EC use in laparoscopic nephrectomy. Twenty patients undergoing laparoscopic nephrectomy between January 2019 and January 2020 at our tertiary referral center were included. Patients were randomly allocated in 2 groups according to energy used, i.e., EC and US. We assessed operative time, blood loss, intra- and postoperative complications, drain output and duration, hospital stay, readmission rates within 30 days of discharge, and surgeon satisfaction with the instruments used. The mean operative time and estimated blood loss were 113 min and 170 ml in EC group while 106 min and 180 ml in US group (p > 0.05). The mean change in hematocrit values after surgery were 6.12% and 5.27% in EC and US group, respectively (p = 0.812). There were no significant differences in mean hospital stay (2.7 in EC group, 2 days in US group), drain output (35.6 ml in EC and 26.3 ml in US group), and drain duration (1.7 days in EC and 1.9 days in US group). One patient in EC group had retroperitoneal hematoma due to Veress needle injury. Similarly only 1 patient in US group had severe intraoperative bleeding requiring conversion to open procedure. Two patients in the EC group had postoperative complications, i.e., fever and purulent collection under surgical site. Electrocautery and ultrasonic shears appear to be comparable in efficacy and safety in laparoscopic nephrectomy. However larger prospective studies are required to confirm our findings.

Epidural Abscess and Sigmoid Sinus Thrombosis as Intracranial Complications of the Middle Ear Cholesteatoma

Abstract The otogenic intracranial complications are rare manifestations in modern era of antibiotics. An early antibiotic therapy often covers typical clinical signs and symptoms for each complication. A sigmoid sinus thrombosis is often associated with other intracranial complications, as in this case, an epidural abscess. We are presenting a case of 12-year-old girl with the sigmoid sinus thrombosis and epidural abscess as complications of chronic infection to the middle ear with cholesteatoma. In the active phase of chronic inflammation of the middle ear she was treated with the antibiotic therapy that covered early symptoms of intracranial complication development. A humid attic perforation of the tympanic membrane with protrusion of choleastoma and evident signs of bony wall destruction to the external auditory canal was noticed by performing routine otomicroscopy and otoendoscopic examination. Assuming intracranial complication, magnetic resonance imaging (MRI) of the endocranium was undertaken. The MRI showed inflammatory changes of both middle ears with intracranial complications: the right sigmoid sinus thrombosis and epidural abscess of the same side. During the surgery we have noticed an extensive middle ear cholesteatoma with significant destruction of the bony tissue and purulent collection between sigmoid sinus changed with granulation and respective dural segment of the posterior cranial cavity. Timely diagnosis, multidisciplinary approach with an adequate choice of the antibiotic therapy and surgical technique have a crucial prognostic significance.

Lower limb bilateral pyomyositis in a diabetic patient: case report and literature review

Pyomiositis is a bacterial infection of skeletal muscle tissue occurring mostly in immunocompromised pa­tients, including diabetics. The main agents are Gram-positive cocci . We report a case of a 42 years old, male, diabetic, who presented the emergency room referring pain in thighs and inability to flex his legs. We performed a magnetic resonance which revealed extensive purulent collections in both lower limbs, thus confirming clinical suspicion, and allowing proper antibiotic treatment. In this case, we showed that imaging tests facilitate early diagnosis and treatment through direct location of the lesions, and guides invasive procedures such as biopsy and abscess aspiration when needed.

Reverse “Y” Shape Fistula - a Paricularity in the Evolution of Postanal Space Abscesses

Horseshoe fistula, with an incidence of less than 3% of the total perianal fistulas, is an atypical lesion not included in the classification of Parks. Its specificity is given by the anatomical features of the postanal space, respectively the presence of the anococcygeal ligament. This type of perineal fistula has a particular tract in shape of a reverse „Y”. We present the cases of 12 patient diagnosed with posterior horseshoe fistula with deep postanal space abscess surgically treated during 2013-2017. The study is retrospective and observative and it includes the history of the disease, the diagnostic methods, the surgical procedures performed and the postoperative evolution. As far as we are concerned, we based our approach on the advancement flap literature data, as well as on the role of the anococcygeal ligament in the pathology of this lesion type. After optimal control of the purulent collection from the postanal space and after the remission of local inflammatory phenomena, a correct advancement flap technique succeeds most often to resolve the septic area of the crypt of origin. We believe that current standards on the functional outcomes of these types of lesions require techniques that avoid the slow elastic cutting of the sphincter, minimizing the risk of incontinence. Keywords: postanal space abscess; anococcygeal ligament; horseshoe fistula; advancement flap

P91 PHARYNGO-OESOPHAGEAL PERFORATION FOLLOWING CERVICAL SPINE SURGERY: A SINGLE CENTRE EXPERIENCE

Abstract Aim Pharyngo-oesophageal perforation is a rare, life-threatening complication of cervical spine surgery. Only isolated cases are reported in the English literature and correct management of these patients remains poorly defined. The aim of this study is to review our experience to better clarify the appropriate treatment of this dreadful complication. Background and Methods Data regarding demographics, clinical course, diagnosis, management and outcomes of 13 patients (8 M, 5F, mean age 49 years) with oesophageal perforation after cervical spine surgery were collected during the period from 2002 to 2019. Results Pharyngo-oesophageal perforation occurred at a median of 8 days (range 0-4745 days) after cervical spine surgery. Clinical manifestations included neck abscess in 7 cases, fever in 3 cases, dysphagia and regurgitation in 3 cases. In 2 patients conservative management with fasting and antibiotics was attempted but, in both cases, a subsequent surgical intervention was required. All patients underwent surgical treatment. A step-up approach with initial surgical drainage of a purulent cervical collection was performed in 7 patients, delaying definitive surgery after resolution of cervical infection. Definitive surgical treatment with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty (either with sternocleidomastoid or pectoralis major muscle flap) was performed in 10 patients. Perforation recurred in two cases, requiring further surgical management. At a median follow-up of 23 months (range 5-149 months) all patients exhibited permanent resolution of the perforation. Conclusions Pharyngo-oesophageal perforation following cervical spine surgery is a rare but dreadful complication: prompt recognition and treatment of these injuries is critical to minimize morbidity and mortality. Partial or total removal of the fixation devices, direct suture of the oesophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients.

A Spontaneous Cholecystocutaneous Fistula Case and Its Management

Objective: Spontaneous cholecystocutaneous fistula is a rare complication of chronic calculous cholecystitis because currently gallstones are diagnosed and treated at an early stage. This occurrence is possible even if it seems actually to be rare. Case Report: We report the case of a 62-year-old woman admitted to the Emergency Department with right hypochondrium pain, weakness. On physical examination, she had fever and discomfort of the upper right abdominal quadrant. Ultrasonography and Computed tomography scans revealed cholecystitis findings with the formation of an abscess. Percutan drainage of the purulent collection was carried out under ultrasound guidance. Cholecystectomy was performed after the patient's comorbid diseases were under controlled. Conclusion: Owing to early diagnosis and treatment of gallbladder diseases, this condition is rarely seen nowadays. We conclude that percutaneous drainage is a safe and less stressful management technique, especially for elderly patients with co-morbidities before Cholecystectomy.

Facial abscess revealing maxillary sinusitis of dental origin

Maxillary sinusitis is exceptionally externalized. We report an unusual case of maxillary sinusitis externalized through the average meatus by following the intersinusonasal bulkhead toward the anterior angle of the maxilla and the nasogenian sulcus. The study involved a patient aged 17 years, with no previous medical history, presenting with facial swelling associated with right nasal obstruction occurred two days before. Clinical examination revealed febrile patient with abscess in the right nasogenian sulcus (A), with total filling of the right nasal fossa by a renitent submucosal bulge. Contrast-enhanced CT scan of the facial bones showed right maxillary sinusitis enlarging the average meatus (B) with collections in the intersinusonasal bulkhead and in the nasogenian sulcus. Furthermore, it showed intrasinusal migration of the 17th tooth root (C). The diagnosis of maxillary sinusitis of dental origin exteriorized to the face was made. Under general anesthesia, drainage of the different purulent collections through an incision in the nasal vestibule, middle meatotomy for drainage of the maxillary sinus and extraction of the 17th tooth were performed. Patient's evolution was favorable with regression of fever and of inflammatory signs.