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患者庄××男42岁于1987年7月13日右侧下牙疼痛,影响咀嚼。8月14日右颜面部肿胀、吞咽疼痛、张口困难,全身伴有畏寒、发热、体温39℃以上。口腔科检查:右下颌角部和腮腺区弥漫肿胀,压痛剧烈。皮肤外观紧张,压之凹陷,可扪到波动感。叩痛明显,牙周红肿。诊断:齿源性颌面部蜂窝织炎。局部穿刺抽出脓液,切开后排出脓液30ml,放引流条,每日换药。全身应用抗生素。术后第3天,热消退,牙疼减轻。两眼先后出现视物模糊(左眼与右眼相差10天)。于8月27日入院。体格检查无异常。视力右眼0.1,左眼0.3,均不能矫正。双外眼及眼前段正常。双眼视乳头充血,境界模糊不清,稍隆起,生理凹陷消失。视网膜静脉充盈纡曲、色深。视乳头周围视网膜水肿,有斑点状渗出物。黄斑区可见黄白色星芒状渗出,中心凹光反射弥散。双眼周边视野轻度向心性缩小,右眼较明显,中心视野有绝对性中心暗点(右8°,左4°)。右眼生理盲点稍扩大。
Patient Zhuang XX male 42 years old on July 13, 1987 the right side of the lower back pain, affecting chewing. August 14 right facial swelling, swallowing pain, mouth opening difficulties, accompanied by chills, fever, body temperature above 39 ℃. Stomatological examination: the right mandibular angle and parotid area diffuse swelling, severe tenderness. Skin appearance tension, depression depression, palpable fluctuations. Percussion pain was obvious, periodontal swelling. Diagnosis: Oral maxillofacial cellulitis. Parenchyma pus out of local puncture, pus after the discharge of 30ml, put drainage, daily dressing change. Systemic antibiotics. On the third day after operation, the heat subsided and the toothache was relieved. The two eyes have blurred vision (left eye and right eye difference of 10 days). Admitted to hospital on August 27. No abnormal physical examination. Right eye 0.1, left eye 0.3, can not be corrected. Double outer eyes and anterior segment normal. Binocular nipple congestion, the state blurred, slightly elevated, physiological depression disappeared. Retinal veins filling song, color depth. Retinal edema around the optic nerve with speckled exudate. Yellow-white area visible yellow star-like exudate, foveal reflex dispersion. The eyes around the eyes mild concentric contraction, the more obvious right eye, center of vision has absolute center dark spots (right 8 °, left 4 °). Right eye physiological blind spot slightly expanded.