Differential Diagnosis
The patient's symptoms of congestion, purulent nasal discharge, upper jaw pain, and tenderness over the left infraorbital foramen, along with the presence of fever and cervical lymphadenopathy, suggest an infectious process. Here's a categorized differential diagnosis:
Single most likely diagnosis
- A. Acute sinusitis: The patient's symptoms of congestion, purulent nasal discharge, and upper jaw pain, which worsens with bending over, are classic for acute sinusitis. The tenderness over the left infraorbital foramen also points towards involvement of the maxillary sinus.
Other Likely diagnoses
- C. Dental abscess: Given the patient's history of several dental fillings on the upper left, a dental abscess could be a possible cause of her symptoms, especially the upper jaw pain. However, the presence of purulent nasal discharge and systemic symptoms like fever and cervical lymphadenopathy make acute sinusitis more likely.
- B. Buccal cellulitis: This could be considered due to the presence of facial pain and tenderness, but the specific involvement of the infraorbital foramen and the nature of the discharge point more towards a sinusitis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Periorbital cellulitis: Although less likely given the description of the pain being more in the upper jaw and the presence of purulent nasal discharge, periorbital cellulitis is a serious condition that can lead to orbital abscess or cavernous sinus thrombosis if not promptly treated.
- Cavernous sinus thrombosis: Not listed as an option but is a critical "do not miss" diagnosis given the patient's symptoms of facial pain, fever, and cervical lymphadenopathy. It's a rare but potentially life-threatening complication of facial or sinus infections.
Rare diagnoses
- E. Trigeminal neuralgia: This condition is characterized by sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. However, it does not typically present with fever, purulent discharge, or systemic signs of infection, making it an unlikely diagnosis in this case.
- Odontogenic infections with complications: While dental infections can lead to serious complications like Ludwig's angina or cavernous sinus thrombosis, the patient's symptoms and examination findings do not strongly suggest these conditions as the primary diagnosis.