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Pertea M, Fotea MC, Luca S, Moraru DC, Filip A, Olinici-Temelie D, Lunca S, Carp AC, Grosu OM, Amarandei A, Veliceasa B. Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment-A New Case Report and Systematic Review. J Pers Med 2023; 13:1612. [PMID: 38003927 PMCID: PMC10672041 DOI: 10.3390/jpm13111612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Necrotizing fasciitis (NF) is a severe and aggressive pathology with a rapid progression and high mortality risk. Periocular NF is a rare condition associated with a lower mortality risk but significantly higher disabling sequelae. (2) Methods: We present the case of a 67-year-old homeless patient, a victim of assault, with multiple untreated comorbidities (diabetes mellitus, cardiac conditions, and schizophrenia) and a delayed diagnosis of periocular necrotizing fasciitis. The condition showed a cyclical evolution influenced by the existing comorbidities, and the patient underwent both surgical and medical treatment with a multidisciplinary team. Additionally, we report a systematic review of cases from the literature. (3) Results: The patient's survival outcomes were favorable; however, the sequelae were disabling, not only concerning aesthetic aspects but also due to the loss of the affected eye globe. The systematic review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature up to this point. (4) Conclusions: Understanding the signs, symptoms, and predisposing factors, as well as the potential rare localizations of NF, including the periocular region, can lead to the early diagnosis and treatment with good functional and aesthetic outcomes, minimizing significant disabilities.
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Affiliation(s)
- Mihaela Pertea
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Stefana Luca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Dan Cristian Moraru
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Filip
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Doinita Olinici-Temelie
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Dermatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Second Surgery Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Adrian Claudiu Carp
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana-Madalina Grosu
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru Amarandei
- Department of Plastic Surgery and Reconstructive Microsurgery, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Bogdan Veliceasa
- Faculty of Medicine, “Grigore T Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (M.P.); (S.L.); (D.C.M.); (D.O.-T.); (S.L.); (A.C.C.); (O.-M.G.); (B.V.)
- Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
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Badabaan G, Creanga AG, Singer SR, Strickland M, Subramanian G. Quantitative indices for cone-beam CT assessment of Medication-Related Osteonecrosis of the Jaw - a scoping review. Saudi Dent J 2023; 35:133-140. [PMID: 36942207 PMCID: PMC10024109 DOI: 10.1016/j.sdentj.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives It is not unusual for Medication-related osteonecrosis of the jaw (MRONJ) lesions that have similar clinical presentation and staging to have dissimilar radiographic extent of disease. The aim of this review was to explore the published scientific literature for quantitative indices that describe the cone-beam computerized tomography (CBCT) radiographic features of MRONJ lesions and assess their clinical utility. Method and Materials A scoping review of the literature was performed to identify quantitative indices developed to describe the CBCT radiographic features of MRONJ lesions. Five electronic databases were included in the review: PubMed, Scopus, Web of Science, Trip medical database, and Cochrane Library. Articles published from the year 2003 onward were included in the review. Results 367 articles were initially included in the review. 39 abstracts were screened for full-text assessment. The scoping review yielded 12 full length articles with169 cases reported. The Composite Radiographic Index score (CRI score) was identified as the most meaningful index in published literature that attempted to quantify qualitative radiographic changes (Walton, Grogan et al. 2019). However, lesions with similar CRI scores that corresponded to intermediate severity (3-5) may be very dissimilar radiographically in both nature and extent of radiographic changes, undercutting its clinical value. Conclusion The CRI index score was the only relevant index for cross-sectional (one-time) assessment of established MRONJ lesions (non-stage 0). This scoping review yielded several critical questions regarding the clinical significance and prognostic implications of various radiographic changes in MRONJ, thereby identifying focus areas for future research.
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Affiliation(s)
- Ghaidaa Badabaan
- Master of Dental Science, Rutgers School of Dental Medicine, Faculty of Dentistry, Umm Al-Qura University, Saudi Arabia
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
- Corresponding author.
| | - Adriana G. Creanga
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
| | - Steven R. Singer
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
| | - Maxine Strickland
- Department of Diagnostic Science, Rutgers School of Dental Medicine, NJ, USA
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Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
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Sacco R, Woolley J, Yates J, Calasans-Maia MD, Akintola O, Patel V. The role of antiresorptive drugs and medication-related osteonecrosis of the jaw in nononcologic immunosuppressed patients: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:23. [PMID: 34221052 PMCID: PMC8240545 DOI: 10.4103/jrms.jrms_794_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/05/2020] [Accepted: 01/28/2021] [Indexed: 10/26/2022]
Abstract
Medication related osteonecrosis of the jaw (MRONJ) is a severe condition affecting the jaws of patients exposed to specific drugs, and is primarily described in patients receiving bisphosphonate (BP) therapy. However, more recently it has been observed in patients taking other medications, such as the RANK ligand inhibitor (denosumab) and antiangiogenic drugs. It has been proposed that the existence of other concomitant medical conditions may increase the incidence of MRONJ. The primary aim of this research was to analyze all available evidence and evaluate the reported outcomes of osteonecrosis of the jaws (ONJ) due to antiresorptive drugs in immunosuppressed patients. A multi-database (PubMed, MEDLINE, EMBASE and CINAHL) systematic search was performed. The search generated twenty-seven studies eligible for the analysis. The total number of patients included in the analysis was two hundred and six. All patients were deemed to have some form of immunosuppression, with some patients having more than one disorder contributing to their immunosuppression. Within this cohort the commonest trigger for MRONJ was a dental extraction (n=197). MRONJ complications and recurrence after treatment was sparsely reported in the literature, however a total of fourteen cases were observed. The data reviewed have confirmed that an invasive procedure is the commonest trigger of MRONJ with relatively high frequency of post-operative complications or recurrence following management. However, due to low-quality research available in the literature it is difficult to draw a definitive conclusion on the outcomes analysed in this systematic review.
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Affiliation(s)
- Roberto Sacco
- The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
| | - Julian Woolley
- King's College Dental Hospital, Oral Surgery Department, London, UK
| | - Julian Yates
- The University of Manchester, Division of Dentistry, School of Medical Sciences, Oral Surgery Department, Manchester, UK
| | | | - Oladapo Akintola
- King's College Dental Hospital, Oral Surgery Department, London, UK
| | - Vinod Patel
- Guy's Dental Hospital, Oral Surgery Department, London, UK
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