18/06/2025
A formidable case, both medically and technically.
This gracious patient underwent resection of a left tonsillar carcinoma two months ago, following unsuccessful chemoradiotherapy and radiation treatment. Post-operatively, she developed trismus, severely restricting her mouth opening. Complicating matters further, tooth 47 (US #31) presented with pulpal necrosis and symptomatic apical periodontitis refractory to Amoxicillin. Thus, we had to access the tooth before more time could be dedicated to enabling a greater amount of opening of the mouth.
Her polypharmacy profile was extensive: Celecoxib for arthritis, Gabapentin for epilepsy, Rabeprazole for Zollinger–Ellison syndrome, Metoprolol for angina, Escitalopram for depression, Clonazepam for panic disorder, and Dapagliflozin for diabetes.
Endodontic access was anything but routine. Gaining access to the C-shaped canal system demanded the entirety of my armamentarium: high-speed burs, severely angled Munce burs, and an ultrasonic tip too. After instrumentation, the mesiobuccal canal coalesced with the mesiolingual and distal canals.
A compelling challenge, but ultimately a gratifying one.
