Indig. child
 

You are operating a rudimentary field hospital for the local population while performing your UW mission. The next person in line is a mother/child combo with the mother very concerned/frantic over the child's new "illness".
Her English is poor and you can't get much history out of her except the following.

She reports that a big bump has arisen inside the mouth of her 6 yr old child. She is very concerned that this could be deadly as it has arisen in the last 48 hours with no other symptoms.

You get the child to open his mouth.. "abra la boca."
You peer inside with your flashlight/tongue depressor.
You, "¿duele?"
The child, "no"

You see the following.... what might it be (differential DX) ? What do you think is it? What should you do based on your Diagnosis? IS THE PATIENT GOING TO DIE as the mother fears?
? :eek:

Yes, the patient is going to die - eventually

Was she eating during or right before this?

What does the exterior look like? Any masses visible outside?

Any numbness in the face? Cranial nerves status?

Any weakness in the facial muscles?

Do I have dental X-ray available?

What labs do I have available?

I'll wait a while for my DX.

Good case.

:munchin

Any other questions by anyone??? If not, hurry up there Docs... this mom is getting very pissed and nervous that it is taking so long to get that medivac chopper in!!!!! Did I mention that this is the G chief's kid and all the village is now watching!!! LOL

No idea...

Not redundant, different. How is facial muscle weakness the same as CN status?

No Xray then. And no biopsy.

I won 't be surprised I don't think. Just ruling out.

I've got it narrowed down to two in my head. With one very much more likely given the patient's age and lack of pain. I don't do well with pics.

What do I feel when I palpate that area and what is the patient's reaction?

That won't help the even more pissed off wife of the G-chief. Her sobbing has just gotten so loud that NORAD heard it on their ears in Alaska!! haha She is now starting to talk as if the gringos have brought this plague upon the people of the village to sabotage them. She didn't seem to like being told it was so rare a problem that even the "gringo medicine man that drops from the skies" that can cure malaria symptoms and terrible infections doesn't know what it is. LOL

Gotta do or say something... Can anyone out there help? It isn't only the 18D that will catch hell if the G tribe loses faith in the Team. :munchin

Guesses? Suggestions?

***edited to correct the good teacher's observation(spelling)

I am not underestimating the great one. I was actually just giving you a MOD to Admin hint in case you were off track.

To answer your question:
Lesion is fluctuant. You possibly feel something boney hard/even sharp underneath upon firm palpation... very limited pain if at all when palpating according to the child.

Abcess ingrown tooth?

Ok, now I'm down to one. I think. I'll wait quietly over here in the corner while Crip, the future 18B, gets the Team run out of the base camp. :munchin

Ouch. I am hearing that alot lately....first TR and now you. You guys are gonna give me a complex. :lifter

So you think it is a .............. You called it abscess so I assume you are Dx'ing an infected tooth?


I am not picking on you Cric.. I have retyped my post over and over trying to make it sound non-aggressive, it doesn't seem to read that way though...SO read the following in a " this is just for your information and a thought process for the future" kind of way.

As to your incision Tx without giving your Dx first .... What if it is a hemangioma and you just started potentially life threatening bleeding with your incision? Or is that not likely in this cyst and therefore been ruled out? If you already ruled it out, then I apologize...if you give me the reason WHY you ruled it out.

YOur treatment is valid for some possibles... what Dx(s) would that be a good treatment for?

HEY APROF members ... THIS IS NOT STRICTLY A CRIC BASHING EVENT..

ANYONE else can chime in... ask questions... make a guess. Cric and NDD are not the only ones responsible for the 80+ views of this thread so far.

:munchin

What, no exploratory surgery?

You and I were typing at the same time on that one. I edited it.

Also I will be the first to admit I have no idea when it comes to oral/dental Dx/Tx. Until now I have never studied it at all.

I also did not take your post that way...

CRIC bashing event huh...I got something for yo ass...

I'll be back after PT.

BTW- Hint...Hint...

ANYONE reading this board that has kids may run into this situation in their lifetime. It is one of the most common lesions seen in a child's mouth.


Cric-
Did you cut the gums in our example scenario? I need to know whether to blow the diversion demo charges and run for it!! LOL

Or maybe... you have been blessed by all the past 18D angels watching over your shoulder and given the right treatment even though you had no idea what you were treating or why it would help?

first part of the answer...
Patient is SIX years old. Time when certain things start happening in that area. What?