case of a 34 year old male

This is the case of a 34 year old male , autodeiver by occupation , resident of West Bengal who presented to the hospital with chief complaints of 

- pus coming out from behind the upper left last molar since 1 month 

History of Presenting Illness

The patient was apparently asymptomatic 1 and a half  year ago when he developed pain in the left jaw . The pain was sudden onset , continuous , dull aching in character, present at the point in the upper left jaw behind the last molar. The patient describes the pain with heaviness of the jaw. The patient visited a doctor who prescribed him pain killers. The pain subsided but reappeared after 1 week of using medication.  No history of trauma 

In the next month , the patient experienced bursting of a swelling in the mouth in the left upper jaw behind the last molar. This resolved the pain completely. 

There was a sudden onset of pus discharged from behind that point . The pus was yellow in color, thick in consistency,serous, appreaded every 1- 2 hours on its own, and also appeared when the patient touched his tongue to the site. The pus was not blood stained. 

The patient visited our hospital and was reffered to the dental department where he underwent surgery. 

For 1 year the patient had no symptoms, 

At present , the patient has a reappearance of pus discharge from the same site with same characteristics. The patient also complains of hearing loss in the left ear, which was insidious in onset, gradually progressive. The patient has difficulty hearing in left ear since 1 year .  There is absence of tinnitus, aural fullness, pain or discharge from the ear.  

For the past 1 month, the patient has had a rise in blood sugars which were detected but no treatment was taken . 

Past History 

The patient has a left eye corneal opacity since childhood. 

Since then the patient has hazy vision in the left eye. 

There is history of dental surgery 

Not a known case of hypertension , TB , Epilepsy.

Family history 

No similar complaints in the family. 

Personal History 

Diet : Mixed 

Appetite : Normal 

Bowel and bladder movements: Normal

Sleep adequate 

Addictions : 

Occasional consumption 

of alcohol. Stopped in 2013. 

History of smoking from 2008 to 2013 - 3 to 4 cigarettes a day .

Chewing of tobacco from 2010 to 2021 

3 to 4 a day . 

Previous reports and admission: 

General examination 

Examination of Ear Nose , Throat

No paranasal sinus tenderness 

Tonsills not visualised

Examination of the eyes 

Left eye : hand movements perceived, opacification seen . 

Bilaterally : pupillary light reflex, accommodation reflex normal

Provisional Diagnosis? 

 recurrent periodontal fistula 

With Diabeties mellitus type 2