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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2010  |  Volume : 28  |  Issue : 3  |  Page : 234-236
 

Cricket ball trauma causing temporal space abscess: Report of a case


1 Consultant Maxillofacial Surgeon, Department of Oral & Maxillofacial Surgery, Deenanath Mangeshkar Hospital, Pimpri, Pune; Professor, Dept. of Pediatric Dentistry, Dr. D Y Patil Dental College and Hospital, Pimpri, Pune, India
2 Senior Lecturer, Department of Oral & Maxillofacial Surgery, Institute of Dental Sciences, Bhubaneshwar, Orissa, India
3 Professor, Department of Pediatric Dentistry, Dr. D Y Patil Dental College and Hospital, Pimpri, Pune, India

Date of Web Publication11-Dec-2010

Correspondence Address:
S Sabhlok
Institute of Dental Sciences, Bhubaneshwar, Orissa
India
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DOI: 10.4103/0970-4388.73785

PMID: 21157061

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   Abstract 

A 9-year-old boy reported with swelling on right side of the face after injury by a cricket ball while fielding. There was a history of hot fermentation after which the swelling increased in size leading to a temporal space abscess. The patient underwent incision and drainage with uneventful healing and was followed-up for a period of 7 years.


Keywords: Cricket ball, temporal space infection


How to cite this article:
Waknis P P, Sabhlok S, Deshpande R. Cricket ball trauma causing temporal space abscess: Report of a case. J Indian Soc Pedod Prev Dent 2010;28:234-6

How to cite this URL:
Waknis P P, Sabhlok S, Deshpande R. Cricket ball trauma causing temporal space abscess: Report of a case. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2014 Apr 24];28:234-6. Available from: http://www.jisppd.com/text.asp?2010/28/3/234/73785



   Introduction Top


Cricket, a religion in India, has a history of trauma to Indian players. From Nari Contractor and Anil Kumble in West Indies to Rahul Dravid in Bangladesh, the cricket ball has caused injury. Sports-related fractures accounted for nearly 21.7% of all fractures, cricket [1] contributing to 7.1%.

Infections of odontogenic origin can spread to fascial spaces requiring incision and drainage along with extraction of offending teeth.

We present a unique case of cricket ball injury leading to temporal space abscess.


   Case Report Top


A 9-year-old boy was brought by his parents with the complaint of swelling and pain on the right side of the face since 2 days. The boy had got hurt with a cricket ball while he was fielding, when he attempted to stop the ball, getting down on his knees. Uneven, sudden bounce caused the ball to jump and hit him. The patient was immediately taken to a pediatrician, given medication, and was sent to a pedodontist to rule out any dental problems. Intraoral examination was normal with no injury to teeth. When the patient returned home, he was given hot fermentation at home by his parents causing a sudden increase in the swelling. The patient was then referred by the pedodontist for further management.

Examination showed an oval swelling on the right side in the temporal region [Figure 1]. The swelling was soft and tender on palpation, leading to a diagnosis of temporal space abscess due to infected hematoma. The patient was hospitalized and started on empirical intravenous antibiotics (i.v. injection augmentin, 12 hourly and metronidiazole, 8 hourly). Routine preoperative investigations were done and the patient was planned for incision and drainage under general anesthesia. An incision 2 cm in length was made in the hairline, approximately 10 mL of pus was evacuated and sent for Gram stain and culture sensitivity. The wound was irrigated with povidone iodine and normal saline. Gauze soaked in povidone iodine was placed and an external dressing was given. Gram staining and culture failed to demonstrate any growth. Daily dressings were done after which the wound was allowed to heal by secondary intention. Healing was uneventful and the patient was followed-up on an annual basis as seen after 7 years [Figure 2] with alopecia due to scarring [Figure 3].
Figure 1: Preoperative photograph

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Figure 2: Seven-year postoperative photograph

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Figure 3: Lateral view showing loss of hair along the incision line

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   Discussion Top


Cricket with its riches and the demi-God status for the players is a way of life in India. Parents in cities, such as Mumbai and Pune, make the children to take up the game in a very serious manner as a hope to a better future. The authors must confess that even though they are followers of the game the fact that junior cricket demands the use of a smaller size ball was not known until research was done for this article. The ball that should be used for junior cricket is slightly smaller (133-144 g), [2] whereas that used in adult cricket is from 155.9 to 163 g. The use of regular ball in junior cricket and uneven grounds can be a potential for injury as was seen in our patient. Ignorance among the parents led to the application of hot fermentation causing the infection. Temporal space infections can be due to many reasons as has been documented in the literature, [3],[4] but a literature search fails to reveal such a unique cause.

The antibiotic of choice was amoxicillin with clavulanic acid as this helps to improve the ability to eradicate bacteria, such as Staphylococcus aureus and Haemophilus influenzae. [5] The review of odontogenic infections and their microbiology show that Penicillin is still the first drug of choice [6],[7] with metronidiazole as a good alternative. [7]

The incision was made superior to the zygomatic arch through the skin and subcutaneous tissue, followed by blunt dissection through the superficial and deep temporal fascia. Daily dressings helped to heal the wound without any complications. The loss of hair along the incision line was a sequelae of scarring as the wound was allowed to heal by secondary intention. Timely referral by the pedodontist, immediate hospitalization, early intravenous antibiotics, and evacuation of pus helped in recovery without the spread of infection to other fascial spaces.


   Conclusion Top


Cricket ball trauma causing a temporal space abscess was a unique case in our experience and it demonstrates once again the potential for injury during the game. The awareness among parents regarding the rules of the size of the ball for junior cricket must be spread to prevent such injuries. A health care system of every club must be mandatory and it is unfortunate that the riches of the game are not reaching the grass root level to develop better infrastructure for ground care and equipment. The patient's parents made him stop the game forever to concentrate on his education.

 
   References Top

1.Antoun JH, Lee KH. Sports related maxillofacial fractures over an 11 year period. J Oral Maxillofac Surg 2008;66:504-8.  Back to cited text no. 1
    
2.Available from: http://www.lords.org [last accessed on 2010 Feb 17].  Back to cited text no. 2
    
3.Haarmann S, Budihardja AS, Hölzle F, Wolff KD. Subcutaneous temporal abscess as a clinical manifestation of pulmonary arteriovenous malformations in a patient with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). Int J Oral Maxillofac Surg 2007;36:1211-4.  Back to cited text no. 3
    
4.Ertas U, Yalcin E. Chronic temporal abscess resulting from a periapical abscess of the upper right first molar. Br J Oral Maxillofac Surg 2009;47:332-3.  Back to cited text no. 4
    
5.James R Hupp. In: Topazian RG, Goldberg MH, Hupp JR, editors. Oral and Maxillofacial Infections. 4th ed. Philadelphia. WB Saunders and Company; 2002. p. 116.  Back to cited text no. 5
    
6.Kulkarni AS, Narayanan V. Bacteriological profile and antibiotic sensitivity patterns in odontogenic abscesses in patients with history of empirical antibiotic therapy. Asian J Oral Maxillofac Surg 2006;18:272-9.  Back to cited text no. 6
    
7.Gill Y, Scully C. Orofacial odontogenic infections: Review of microbiology and current treatment. Oral Surg Oral Med Oral Pathol 1990;70:155-8.  Back to cited text no. 7
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    Figures

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    Abstract
    Introduction
    Case Report
    Discussion
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    References
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