Abscess of the Antrum Caused by a Tooth. [Volume: 2, Issue: 10, May, 1861, pp. 538-540]

ABSCESS OF THE ANTRUM CAUSED BY A TOOTH.

539

body was rather above the average temperature. This was the condition
of the patient when he called at the office, having been sent to Dr. White
by his physician.
Upon examining the anterior nares, nothing could be discovered to
account for the discharge, the mucous membrane being a little inflamed,
but not sufficiently to occasion it. A diseased state of the antrum was
suspected, and the mouth was examined to ascertain if a diseased tooth
could be the cause. The second molar, upper jaw, right side, was unsound; part of the crown was decayed away; the bulbous portion of the
nerve and the filaments in the buccal roots were dead; but that part in
the palatine root was living, and occasioned the patient pain; a little
arsenical paste was applied to destroy it; no signs of alveolar abscess
were present in it or any other tooth. Not having time to make a fuller
examination, the patient was sent away with the request to call the following day. The patient came at the appointed time; the nerve in the
palatine root was removed without trouble; a careful inspection was now
made, and important information was received. Upon examining the
right nostril with a speculum, a little pus was seen in the middle meatus.
The patient was requested to incline the head toward the left side; he
did so; and upon looking at the parts again a large amount of pus was
found. This, together with the facts stated already in this paper, and
that there was no other assignable cause of the discharge, were deemed
sufficient to establish the diagnosis-abscess of the antrum, probably
caused by the unsound second molar tooth.
Extraction of the tooth was advised and submitted to. Upon the
removal of the tooth no pus escaped; a probe was introduced into the
alveolus previously occupied by one of the buccal roots and readily passed
on into the antrum; pus now followed the withdrawal of the instrument.
Some suppose that when a tooth is drawn which communicates with
the antrum in which there is pus, a discharge must necessarily follow;
this is a mistake, as is seen by this case, and has been seen in many
others. The cause of this may be the smallness of the aperture, or on
account of the communication between the nose and the antrum becoming
obstructed, by the approximation of the inflamed mucous membrane
around the passage. The antrum is then like a narrow-necked bottle
filled with fluid and turned upside down, no fluid escaping on account of
atmospheric pressure.
It is, on this account, in a case of suspected abscess, if no pus follows
the extraction of the tooth, always necessary to pass up a probe; if pus
be present it will be perceived when the instrument is withdrawn.
The cavity was now syringed out with tepid water, when a large quantity of pus mixed with water escaped through the nose. The fluid was
very fetid, and was received on a napkin, to avoid soiling the patient's
clothes.