Periapical Infection Masquerading as a Nasal Pustule
A 28-year-old male presented at the Restorative dental clinic, University of Benin Teaching Hospital, Benin City, Nigeria with a discolored maxillary left central incisor (tooth #11) of 4 years duration [], patient could not remember what happened to the tooth, examination of the tooth revealed Ellis class I fracture on the mesial incisial edge of the tooth. However, there was no carious lesion on the tooth. Pulp sensibility test with electric pulp tester was not responsive, and periapical radiolucency was evident in the periapical radiograph. Root canal treatment was commenced on tooth #11 immediately, through an access cavity on the palatal surface of the tooth. The canal was irrigated with 0.9% saline and 2.5% sodium hypochlorite solution. Intracanal medicament (calcium hydroxide) was placed in the canal, and the access cavity was temporarily sealed with zinc oxide eugenol. Patient was given a 2 day appointment for determination of working length of the tooth since the working length was not determined during the initial visit because of time constrains and continuation of the root canal treatment. Patient showed up for his appointment, examination revealed that the tooth was asymptomatic, but there was a discharging sinus in the floor of the right nostril [].\nA further history revealed that the patient had been under the care of an Otorhinolargngologist for about 2 years for the treatment of the discharging sinus that he had been on several antibiotics, which he could not remember their names. The temporary seal and intracanal medicament were removed and the canal was checked using paper points, pus was revealed in the canal. Canal was the irrigated with 2.5% sodium hypochlorite and 0.9% saline alternatively. The working length was established at 29 mm using radiographic method [].\nBiomechanical preparation of the canal was done using the step back under copious irrigation. Non-setting calcium hydroxide dressing was placed in the canal as inter-appointment medicament and the patient was giving a 4 week appointment. Patient returned 4 weeks later symptom free and complete healing of the sinus in the floor of the right nostril. Canal was obturated with guttapercha using the cold lateral condensation technique []. Access was sealed with glass ionomer cement and the patient was given a 1 month review appointment. Review after 1 month showed that the patient was asymptomatic, and there was no sinus in the floor of the nose, Subsequent reviews at the 3 months and 6 months revealed no symptoms.