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Gangolli R, Pushalkar S, Beutel BG, Danna N, Duarte S, Ricci JL, Fleisher K, Saxena D, Coelho PG, Witek L, Tovar N. Calcium Sulfate Disks for Sustained-Release of Amoxicillin and Moxifloxacin for the Treatment of Osteomyelitis. MATERIALS (BASEL, SWITZERLAND) 2024; 17:4086. [PMID: 39203264 PMCID: PMC11356595 DOI: 10.3390/ma17164086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024]
Abstract
The purpose of this in vitro study was to develop calcium sulfate (CS)-based disks infused with an antimicrobial drug, which can be used as a post-surgical treatment modality for osteomyelitis. CS powder was embedded with 10% antibiotic, amoxicillin (AMX) or moxifloxacin (MFX), to form composite disks 11 mm in diameter that were tested for their degradation and antibiotic release profiles. For the disk degradation study portion, the single drug-loaded disks were placed in individual meshes, subsequently submerged in phosphate-buffered saline (PBS), and incubated at 37 °C. The disks were weighed once every seven days and analyzed via Fourier-transform infrared spectroscopy, X-ray diffraction, energy dispersive X-ray spectroscopy, and scanning electron microscopy. During the antibiotic release analysis, composite disks were placed in PBS solution, which was changed every 3 days, and analyzed for antibiotic activity and efficacy. The antibacterial effects of these sustained-release composites were tested by agar diffusion assay using Streptococcus mutans (S. mutans) UA 159 as an indicator strain. The degradation data showed significant increases in the degradation of all disks with the addition of antibiotics. Following PBS incubation, there were significant increases in the amount of phosphate and decreases in the amount of sulfate. The agar diffusion assay demonstrated that the released concentrations of the respective antibiotics from the disks were significantly higher than the minimum inhibitory concentration exhibited against S. mutans over a 2-3-week period. In conclusion, CS-antibiotic composite disks can potentially serve as a resorbable, osteoconductive, and antibacterial therapy in the treatment of bone defects and osteomyelitis.
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Affiliation(s)
- Riddhi Gangolli
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
| | - Smruti Pushalkar
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY 10003, USA
| | - Bryan G. Beutel
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
| | - Natalie Danna
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
| | - Simone Duarte
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, NY 14215, USA
| | - John L. Ricci
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
| | - Kenneth Fleisher
- Department of Oral and Maxillofacial Surgery, NYU Dentistry, New York, NY 10010, USA
| | - Deepak Saxena
- Department of Molecular Pathobiology, NYU Dentistry, New York, NY 10010, USA;
| | - Paulo G. Coelho
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA;
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL 33146, USA
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY 11201, USA
| | - Nick Tovar
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA (B.G.B.); (L.W.)
- Department of Oral and Maxillofacial Surgery, NYU Dentistry, New York, NY 10010, USA
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Dugena O, Sidebottom A. Condylar osteomyelitis: A case report of a rare complication of maxillary dental extraction. Natl J Maxillofac Surg 2024; 15:154-156. [PMID: 38690240 PMCID: PMC11057594 DOI: 10.4103/njms.njms_189_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2024] Open
Abstract
Condylar osteomyelitis is a long-standing infection of the condylar head of the mandible. The chronic progression of this disease can lead to the destruction of surrounding bony structures and can ultimately affect function. Currently, in English Literature, there have been few cases published on condylar osteomyelitis. Interestingly, regardless of proximity, there have only been two other reported cases of condylar osteomyelitis subsequent to extractions of the upper maxillary third molar. We report a case of a 27-year-old female who presented with an acute episode of condylar osteomyelitis after a simple extraction of an upper left third molar. Several courses of antibiotics did not alleviate her severe trismus, paresthesia, or extensive preauricular collection. Three surgical interventions showed negative growth on numerous swabs. However, CT scans and an MRI confirmed extensive osteomyelitis along the left head, neck, and the angle of the mandible. Following inpatient IV antibiotics, the patient was discharged with a PICC line to allow for long-term treatment. An improvement in function, pain, and swelling was seen on discharge. However, due to the nature of this disease she was monitored for 2 years and due to joint collapse has been listed for alloplastic replacement.
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Affiliation(s)
- Oliver Dugena
- Oral and Maxillofacial Senior House Surgeon, Queens Medical Centre, Derby Road, Lenton, Nottingham NG72UH, UK
| | - Andrew Sidebottom
- Oral and Maxillofacial Surgeon, Spire Nottingham Hospital, Tollerton Lane, Nottingham, UK
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3
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Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2023; 81:E221-E262. [PMID: 37833025 DOI: 10.1016/j.joms.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Fenelon M, Gernandt S, Aymon R, Scolozzi P. Identifying Risk Factors Associated with Major Complications and Refractory Course in Patients with Osteomyelitis of the Jaw: A Retrospective Study. J Clin Med 2023; 12:4715. [PMID: 37510830 PMCID: PMC10380926 DOI: 10.3390/jcm12144715] [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: 05/28/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Despite improved knowledge regarding the diagnosis and treatment of osteomyelitis of the jaw (OMJ), it remains a clinical challenge for oral and maxillofacial surgeons. This study aimed to identify risk factors associated with severe forms of OMJ, i.e., related to the occurrence of major complications or the refractory course of the disease. A retrospective study was performed based on the medical records of all patients diagnosed with OMJ from the past 20 years. Collected data included demographic information, medical and dental history, clinical, radiological, and bacterial findings as well as treatment modalities. The main outcome variables were the onset of major complications and treatment results. Fifty-four patients were included. Our results showed that alcohol and smoking habits, as well as malnutrition, were significantly associated with the occurrence of major complications. We also established that dental implant-induced OMJ should be considered an aggressive subtype of OMJ. Finally, clinical bone exposure was significantly associated with unfavorable outcomes, whereas dental causes or radiological evidence of periosteal reaction were predictive of successful outcomes. Identifying such factors could be useful in preventing serious complications and informing patients about the refractory course of the disease based on the presence of these factors.
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Affiliation(s)
- Mathilde Fenelon
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- UFR des Sciences Odontologiques, University Bordeaux, 33000 Bordeaux, France
- Service de Chirurgie Orale, CHU de Bordeaux, 33000 Bordeaux, France
| | - Steven Gernandt
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Romain Aymon
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
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Khalil W. A New Approach for Explaining and Treating Dry Sockets: A Pilot Retrospective Study. Cureus 2023; 15:e41347. [PMID: 37546073 PMCID: PMC10398614 DOI: 10.7759/cureus.41347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Objective Dry socket, a common complication following a tooth extraction, is characterized by severe and radiating pain that typically begins one to four days after the extraction. Despite several risk factors, the exact cause and underlying mechanisms of dry sockets remain unclear. This study aims to propose a novel pathogenesis and management approach for dry sockets based on an infectious process. Methods The study was conducted by reviewing medical records, at a private dental clinic, of patients who fit the inclusion criteria; these patients appeared to have come between April 2022 and April 2023. The study included all patients with age ≥17 years diagnosed with dry socket that was resistant to conventional topical treatment, and who received treatment with ciprofloxacin 500 mg three times per day during the study period. Results Out of 15 patients who received treatment with ciprofloxacin 500 mg three times per day during the study period, 11 patients (73.3%) were completely relieved of symptoms within 24 hours, with no need for additional painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, two patients (13.3%) had a partial response after 48 hours, where their pain was ameliorated from severe to moderate with the use of conventional painkillers (including paracetamol and NSAIDs) and steroidal anti-inflammatory drugs such as dexamethasone (8 mg IM daily) to have total relief. On the other hand, the other two patients (13.3%) had a negative response to the treatment and were out of reach for follow-up. Conclusion These clinical outcomes, coupled with previous laboratory data, could explain all clinical aspects of dry sockets and provide substantial support for the hypothesis that an infectious mechanism plays the principal role in the pathophysiology of dry sockets.
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Affiliation(s)
- Wael Khalil
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, LBN
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[18F]Fluoride Positron-Emission Tomography (PET) and [18F]FDG PET for Assessment of Osteomyelitis of the Jaw in Comparison to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): A Prospective PET/CT and PET/MRI Pilot Study. J Clin Med 2022; 11:jcm11143998. [PMID: 35887762 PMCID: PMC9323701 DOI: 10.3390/jcm11143998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 12/19/2022] Open
Abstract
To investigate imaging features of osteomyelitis of the jaw (OMJ) using [18F]fluoride positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG)-PET compared with computed tomography (CT) and magnetic resonance imaging (MRI) to assess extent and disease activity. Six female patients (55.3 ± 10.0 years) were enrolled for assessment of symptomatic OMJ. 4/6 patients underwent [18F]FDG-PET/MRI and [18F]fluoride-PET/CT, one patient MRI and [18F]fluoride-PET/CT and another patient only [18F]FDG-PET/MRI. Image analysis was performed by two radiologists, an oral and maxillofacial surgeon, and a nuclear medicine specialist. The extent of affected jawbone was analyzed both qualitatively and quantitatively, including the PET tracer uptake, CT-Hounsfield-Units (HU) and MRI parameters in affected and healthy jawbone. All patients had trabecular sclerosis in the affected jawbone compared to healthy jawbone (560 ± 328 HU vs. 282 ± 211 HU; p > 0.05), while 3/6 patients had cortical erosions. Bone marrow edema and gadolinium enhancement were documented in 5/6 patients. In affected jawbone, [18F]fluoride-uptake was increased in all patients compared to healthy jawbone (SUVmean 15.4 ± 4.2 vs. 2.1 ± 0.6; p < 0.05), and [18F]FDG-uptake was moderately higher (SUVmean 1.9 ± 0.7 vs. 0.7 ± 0.2; p > 0.05). The extent of regions with increased metabolic activity was less than the extent of morphologic changes in all patients. Information on jawbone metabolism and inflammation is different from morphologic changes and therefore has the potential to provide a more accurate and objective assessment of the extent and activity of OMJ.
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He P, Francois K, Missaghian N, Le AD, Flynn TR, Shanti RM. Are Bacteria Just Bystanders in the Pathogenesis of Inflammatory Jaw Conditions? J Oral Maxillofac Surg 2022; 80:1094-1102. [DOI: 10.1016/j.joms.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Zhou Z, Chen Y, Min HS, Wan Y, Shan H, Lin Y, Xia W, Yin F, Jiang C, Yu X. Merlin functions as a critical regulator in Staphylococcus aureus-induced osteomyelitis. J Cell Physiol 2021; 237:815-823. [PMID: 34378805 DOI: 10.1002/jcp.30550] [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: 04/19/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
Merlin is known as a tumor suppressor, while its role in osteomyelitis remains unclear. This study aimed to investigate the role of Merlin in Staphylococcus aureus-induced osteomyelitis and its underlying mechanisms. S. aureus-induced osteomyelitis mouse model was established in Merlinfl/fl Lyz2cre/+ and Merlinfl/fl Lyz2+/+ mice. Bone marrow-derived macrophages (BMDMs) were isolated and stimulated by lipopolysaccharide (LPS). Bioassays, including quantitative reverse transcription polymerase chain reaction (qRT-PCR), Western blot analysis, and enzyme-linked immunosorbent assays, were conducted to determine the levels of target genes or proteins. Immunoprecipitation was applied to determine the interactions between proteins. DCAF1fl/fl mice were further crossed with Lyz2-Cre mice to establish myeloid cell conditional knockout mice (DCAF1fl/fl Lyz2cre/+ ). It was found that the level of Merlin was elevated in patients with osteomyelitis and S. aureus-infected BMDMs. Merlin deficiency in macrophages suppressed the production of inflammatory cytokines and ameliorated the symptoms of osteomyelitis induced by S. aureus. Merlin deficiency in macrophages also suppressed the production of proinflammatory cytokines in BMDMs induced by LPS. The inhibitory effects of Merlin deficiency on the inflammatory response were associated with DDB1-Cul4-associated factor 1 (DCAF1). In summary, Merlin deficiency ameliorates S. aureus-induced osteomyelitis through the regulation of DCAF1.
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Affiliation(s)
- Zubin Zhou
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuanliang Chen
- Department of Orthopaedic Surgery, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People's Hospital, Haikou, Hainan, China
| | - Hong Sung Min
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yongbai Wan
- Department of Orthopaedic Surgery, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People's Hospital, Haikou, Hainan, China
| | - Haojie Shan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yiwei Lin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenyang Xia
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fuli Yin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chaolai Jiang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaowei Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Degloving Approach for the Management of Extensive Mandibular Osteomyelitis. J Craniofac Surg 2021; 32:e230-e233. [PMID: 32868722 DOI: 10.1097/scs.0000000000006960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Extensive osteomyelitis of the mandible is usually managed using elaborate procedures including resection and reconstruction of the affected part of the mandible. This brief clinical report, the authors present a case of 75-year old male with extensive osteomyelitis of the mandible, incidentally diagnosed with anemia of chronic disease and Type I diabetes mellitus and managed using an intraoral degloving approach exclusively. This has proved to be a procedure ensuring better blood supply, decreased morbidity, precluding an elaborate reconstruction procedure and an overall reduction in cost. The advantages, scientific basis, rationale and pitfalls have been discussed briefly.
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10
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Diabetic Maxillary Osteomyelitis: A Worrisome Vulnerability—Our Experience. J Maxillofac Oral Surg 2020; 21:590-598. [DOI: 10.1007/s12663-020-01371-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022] Open
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Yahara H, Horita S, Yanamoto S, Kitagawa Y, Asaka T, Yoda T, Morita K, Michi Y, Takechi M, Shimasue H, Maruoka Y, Kondo E, Kusukawa J, Tsujiguchi H, Sato T, Kannon T, Nakamura H, Tajima A, Hosomichi K, Yahara K. A Targeted Genetic Association Study of the Rare Type of Osteomyelitis. J Dent Res 2020; 99:271-276. [PMID: 31977282 DOI: 10.1177/0022034520901519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic nonbacterial osteomyelitis is a rare bone disorder that can be found in the jaw. It is often associated with systemic conditions, including autoimmune deficiencies. However, little is known about how the genetic and immunologic background of patients influences the disease. Here, we focus on human leukocyte antigen (HLA), killer cell immunoglobulin-like receptors (KIRs), and their specific combinations that have been difficult to analyze owing to their high diversity. We employed a recently developed technology of simultaneous typing of HLA alleles and KIR haplotype and investigated alleles of the 35 HLA loci and KIR haplotypes composed of centromeric and telomeric motifs in 18 cases and 18 controls for discovery and 472 independent controls for validation. We identified an amino acid substitution of threonine at position 94 of HLA-C in combination with the telomeric KIR genotype of haplotype tA01/tB01 that had significantly higher frequency (>20%) in the case population than in both control populations. Multiple logistic regression analysis based on a dominant model with adjustments for age and sex revealed and validated its statistical significance and high predictive accuracy (C-statistic ≥0.85). Structure-based analysis revealed that the combination of the amino acid change in HLA-C and the telomeric genotype tA01/tB01 could be associated with lower stability of HLA-C. This is the first case-control study of a rare disease that employed the latest sequencing technology enabling simultaneous typing and investigated amino acid polymorphisms at HLA loci in combination with KIR haplotype.
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Affiliation(s)
- H Yahara
- Department of Molecular Immunology and Inflammation, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - S Horita
- Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - S Yanamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Y Kitagawa
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - T Asaka
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Morita
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Bioresource Research Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Michi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Takechi
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - H Shimasue
- Department of Oral and Maxillofacial Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Maruoka
- Department of Oral and Maxillofacial Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - E Kondo
- Department of Dentistry and Oral Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
| | - J Kusukawa
- Dental and Oral Medical Center, School of Medicine, Kurume University, Fukuoka, Japan
| | - H Tsujiguchi
- Department of Environmental and Preventive Medicine, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - T Sato
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - T Kannon
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - H Nakamura
- Department of Environmental and Preventive Medicine, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - A Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - K Hosomichi
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - K Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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Maxillofacial Osteomyelitis in Immunocompromised Patients: A Demographic Retrospective Study. J Maxillofac Oral Surg 2019; 19:273-282. [PMID: 32346240 DOI: 10.1007/s12663-019-01201-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
Abstract
Objective To retrospectively study the cases diagnosed with osteomyelitis of jaw in AMC Dental Hospital. Study Design A total of 27 cases of osteomyelitis of jaw were analysed retrospectively from 2014 to 2018 at Department of oral and maxillofacial surgery, AMC Dental Hospital, Ahmedabad, India. Result Totally 27 cases of osteomyelitis were noted; 12 (44.44%) patients had involvement of maxilla, and 15 (55.55%) patients had involvement of the mandible. Twenty-one patients had underlying systemic disease, and 13 patients had history of substance abuse. The underlying aetiology in 20 patients was found due to odontogenic cause. There were only 3 patients having osteomyelitis without any underlying disease or any other predisposing factors. Conclusion Incidence of osteomyelitis and its outcome in the present study led to a better understanding of the aetiologic factors and its treatment. The results hypothesized a substantial correlation for onset of osteomyelitis with the underlying medical conditions and substance abuse. There was a higher correlation found between comorbid conditions and osteomyelitis of maxilla. Thorough study of the treatment revealed that conventional treatment plan is adequate for treating cases of osteomyelitis if the associated medical problem is also simultaneously treated and given due importance.
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Comorbid conditions are a risk for osteonecrosis of the jaw unrelated to antiresorptive therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:140-150. [DOI: 10.1016/j.oooo.2018.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/23/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
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14
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Kudva A, Kamath AT, Dhara V, Ravindranath V. Chronic recurrent osteomyelitis: A surgeon's enigma. J Oral Pathol Med 2019; 48:180-184. [PMID: 30565322 DOI: 10.1111/jop.12814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis. METHODS A thorough workup which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti-inflammatory with or without surgical debridement/adjuvant therapies. Correlation of our findings and treatment plan was done with evidence-based literature and practice. RESULTS Complete resolution of symptoms with radiographic evidence was achieved in both the cases. In the recurrence period, long-term steroids, NSAIDs, antibiotics resulted in better outcomes. CONCLUSION The evidence-based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom-free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Abhay T Kamath
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Vasantha Dhara
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Vineetha Ravindranath
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Karnataka, India
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15
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Souza LCD, Lopes FF, Bastos EG, Alves CMC. Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report. ACTA ACUST UNITED AC 2018; 40:82-85. [PMID: 29796582 PMCID: PMC6533965 DOI: 10.1590/1678-4685-jbn-3812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
Chronic renal patients are more susceptible to hospital complications and
infections such as urinary tract infections, peritonitis, surgery infections,
and bacteremia, which are often caused by Pseudomonas
aeruginosa. A case of a HIV-positive girl with chronic kidney
disease and with serious oral lesions due to P. aeruginosa
septic shock is presented. The patient showed necrotic lesions in the oral
mucosa, pathological tooth mobility, bone loss, and hematogenous osteomyelitis
in the maxilla. The patient was submitted to systemic antibiotic therapy based
on screening culture and treatment of bone lesions by eliminating the causal
agent and restoring health conditions. This case report is extremely important
for health professionals, since the oral cavity can be affected by this pathogen
or serve as a colonization site.
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Schlund M, Raoul G, Ferri J, Nicot R. Mandibular Osteomyelitis Following Implant Placement. J Oral Maxillofac Surg 2017; 75:2560.e1-2560.e7. [PMID: 28850817 DOI: 10.1016/j.joms.2017.07.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Mandibular osteomyelitis is relatively rare except in cases of osteoradionecrosis or medication-related osteonecrosis. The purpose of this case report is to highlight a rare but devastating complication of dental implant surgery. MATERIALS AND METHODS The case of a patient who developed mandibular osteomyelitis after implant placement, which was resistant to long-term antibiotic therapy and required radical surgical treatment with fibular free flap reconstruction, is reviewed as is the related literature. RESULTS The most frequent etiologies are odontogenic and traumatic; however, hematogenous spread also exists. It usually affects patients with systemic conditions, such as diabetes mellitus, malnutrition, malignancy, or immune deficiency. The infection is usually polymicrobial. Concerning dental implant complications, the literature is comprehensive on the mechanical etiologies of implant failure and the infectious etiologies of peri-implantitis. Mandibular osteomyelitis treatment is a long and challenging process requiring long-term antibiotic therapy and multiple surgeries. CONCLUSION The pathophysiology and treatment of mandibular osteomyelitis are discussed.
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Affiliation(s)
- Matthias Schlund
- Resident, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille, France.
| | - Gwenael Raoul
- Professor, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille; INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | - Joel Ferri
- Department Head, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille; INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | - Romain Nicot
- Chief Resident, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille, France
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McCoy JM, Oreadi D. Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2017; 75:e224-e263. [DOI: 10.1016/j.joms.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hudson JW, Daly AP, Foster M. Treatment of Osteomyelitis: A Case for Disruption of the Affected Adjacent Periosteum. J Oral Maxillofac Surg 2017; 75:2127-2134. [PMID: 28396232 DOI: 10.1016/j.joms.2017.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution. PATIENTS AND METHODS A retrospective review was conducted of 7 patient charts with associated radiographs from November 2010 to August 2016 treated by the first author at the University of Tennessee Medical Center (Knoxville, TN). Patients with chronic suppurative or nonsuppurative osteomyelitis of the mandible without condylar involvement or pathologic fracture were selected and treated with decortication with periosteal disruption in combination with long-term targeted antibiotic therapy. RESULTS Seven patients (3 women and 4 men; mean age, 60 yr) underwent decortication with periosteal disruption of the affected area and received at least 6 weeks of targeted intravenous antibiotics. Computed tomography was performed preoperatively and a repeat study was performed after completion of antibiotics. In each case, post-treatment imaging showed definitive resolution after treatment with decortication in concert with disruption of the inflamed hypertrophic periosteum and intravenous antibiotics. CONCLUSION Debridement of the infected cortical bone with restoration of the blood supply through disruption of the adjacent periosteum provided definitive resolution of mandibular osteomyelitis in the 7 patients treated. The hypothesis is that disruption of the affected adjacent periosteum reintroduces an immune-mediated response in concert with improved antibiotic delivery to and penetrance of the diseased mandible, aiding in definitive resolution. Decortication with periosteal disruption allows for preservation of the inferior alveolar nerve, maintains mandibular integrity, and obviates reconstructive surgery. Decortication with disruption of the adjacent periosteum, when combined with targeted antimicrobial therapy, produced definitive resolution of osteomyelitis as shown by postoperative imaging. It is the authors' assertion that not only decortication, but also disruption of the adjacent periosteum in combination with targeted antibiotic therapy should be considered a valid and principal therapeutic option for the surgical treatment of osteomyelitis of the mandible.
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Affiliation(s)
- John W Hudson
- Professor, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
| | - Austin P Daly
- Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Michael Foster
- Private Practitioner, Associated Oral and Implant Surgeons, Johnson City, TN
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Osteomyelitis of the Mandibular Condyle: A Report of 2 Cases With Review of the Literature. J Oral Maxillofac Surg 2016; 75:322-335. [PMID: 27649464 DOI: 10.1016/j.joms.2016.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/22/2022]
Abstract
In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible more often than not is odontogenic in origin and the dentate part is usually affected. In this context, involvement of the condyle and coronoid processes is very rare. This report describes 2 unique cases of condylar involvement with osteomyelitis. In these cases, the etiologies were unknown and were successfully managed by condylectomy and antibiotics. A comprehensive review of the English-language literature showed only 18 cases of osteomyelitis of the condyle. Odontogenic, otologic, and tubercular causes were the most common causes of osteomyelitis of the condyle. Radiologically, the condyle usually appeared osteolytic and eroded in osteomyelitis and radionucleotide scans were helpful in localizing the inflammation site. In most cases, condylectomy with appropriate antibiotics was required to eliminate the disease.
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Does Fluorodeoxyglucose Positron Emission Tomography With Computed Tomography Facilitate Treatment of Medication-Related Osteonecrosis of the Jaw? J Oral Maxillofac Surg 2016; 74:945-58. [DOI: 10.1016/j.joms.2015.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 12/31/2022]
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Maxillary chronic osteomyelitis caused by domestic violence: a diagnostic challenge. Case Rep Dent 2015; 2014:930169. [PMID: 25610667 PMCID: PMC4291137 DOI: 10.1155/2014/930169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022] Open
Abstract
Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.
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Effects of gatifloxaine content in gatifloxacine-loaded PLGA and β-tricalcium phosphate composites on efficacy in treating osteomyelitis. Odontology 2014; 104:105-13. [DOI: 10.1007/s10266-014-0187-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
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Chronic osteomyelitis of the mandible: diagnosis and management--an institution's experience over 7 years. J Oral Maxillofac Surg 2014; 73:655-65. [PMID: 25577460 DOI: 10.1016/j.joms.2014.10.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/10/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of this study was to retrospectively evaluate and report the associated factors with the diagnosis and management of 24 patients with chronic osteomyelitis of the mandible seen at the authors' institution during the past several years. PATIENTS AND METHODS Only cases of chronic osteomyelitis of the mandible not associated with antiresorptive medications or radiotherapy to the maxillofacial region were included in the study. After confirmation of the diagnosis, initial clinical and radiologic findings, treatment approach, and outcome were evaluated for each patient. Fourteen male and 10 female patients (average age, 53.75 yr; range, 22 to 83 yr) were included. RESULTS The peak incidence of the disease was recorded in the fifth and sixth decades of life. An uneventful healing was observed in 20 patients (83.3%). One of 18 patients (5.5%) who underwent segmental resections developed a secondary infection and was managed with intravenously administered antibiotics. Three of 6 patients (50%) who were treated with marginal resections remained symptomatic after surgery. CONCLUSION Independent of the cause and presentation of the disease, complete resolution of the infection should be the main focus of management in patients with chronic osteomyelitis of the mandible, and findings of this retrospective study indicate that a conservative surgical approach is more likely to result in a less than ideal outcome.
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Fluorodeoxyglucose Positron Emission Tomography With Computed Tomography Detects Greater Metabolic Changes That Are Not Represented by Plain Radiography for Patients With Osteonecrosis of the Jaw. J Oral Maxillofac Surg 2014; 72:1957-65. [DOI: 10.1016/j.joms.2014.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 12/17/2022]
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Mendonca D, Kenkere D. Avoiding occlusal derangement in facial fractures: An evidence based approach. Indian J Plast Surg 2014; 46:215-20. [PMID: 24501457 PMCID: PMC3901902 DOI: 10.4103/0970-0358.118596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.
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Affiliation(s)
- Derick Mendonca
- Department of Plastic and Reconstructive Surgery, Bangalore Baptist Hospital, Bangalore, Karnataka, India
| | - Deepika Kenkere
- Department of Maxillofacial Surgery, Bangalore Baptist Hospital, Bangalore, Karnataka, India
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Sharma N, Batra H, Mehta M, Chander J. Maxillary Osteomyelitis Caused by Apophysomyces Variabilis - Emerging Trends. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the maxillofacial skeleton, chronic osteomyelitis is more often observed in the mandible than maxilla. Maxillary osteomyelitis is rare because of its rich blood supply. It is usually seen in individuals with impaired immune response, uncontrolled diabetes and hospitalized patients. It can be caused by bacterial, fungal or viral infections. We report a rare case of maxillary osteomyelitis caused by an emerging mucormycete, Apophysomyces variabilis.
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Clinical management of suppurative osteomyelitis, bisphosphonate-related osteonecrosis, and osteoradionecrosis: report of three cases and review of the literature. Case Rep Dent 2013; 2013:402096. [PMID: 24222866 PMCID: PMC3814104 DOI: 10.1155/2013/402096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.
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Carlson ER, Ghali GE, Herb-Brower KE. Diagnosis and management of pathological conditions. J Oral Maxillofac Surg 2012; 70:e232-71. [PMID: 23128003 DOI: 10.1016/j.joms.2012.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Microbiota associated with infections of the jaws. Int J Dent 2012; 2012:369751. [PMID: 22829824 PMCID: PMC3399405 DOI: 10.1155/2012/369751] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 05/09/2012] [Accepted: 05/18/2012] [Indexed: 01/28/2023] Open
Abstract
The microbial infections involving the craniofacial skeleton, particularly maxilla and mandible, have direct relationship with the dental biofilm, with predominance of obligate anaerobes. In some patients, these infections may spread to bone marrow or facial soft tissues, producing severe and life-threatening septic conditions. In such cases, local treatment associated with systemic antimicrobials should be used in order to eradicate the sources of contamination. This paper discuss the possibility of spread of these infections and their clinical implications for dentistry, as well as their etiology and aspects related to microbial virulence and pathogenesis.
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Ostrowski RP, Lo T, Zhang JH. The pacific chapter annual meeting of the undersea & hyperbaric medical society. Med Gas Res 2011; 1:19. [PMID: 22146426 PMCID: PMC3231977 DOI: 10.1186/2045-9912-1-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/04/2011] [Indexed: 12/02/2022] Open
Abstract
The following is the summary report on the UHMS Pacific Chapter Annual Meeting held in Long Beach in October 2010. The conference provided the latest updates on scientific, technical and organizational aspects of Hyperbaric and Diving Medicine. Invited speakers gave series of lectures dealing with current standards of clinical practice and presenting the results of laboratory investigations with particular emphasis on mechanisms of hyperbaric oxygen therapy. Scientific sessions were accompanied by vendor exhibits and social events.
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Affiliation(s)
- Robert P Ostrowski
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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Vega LG. Reoperative mandibular trauma: management of posttraumatic mandibular deformities. Oral Maxillofac Surg Clin North Am 2011; 23:47-61, v-vi. [PMID: 21272766 DOI: 10.1016/j.coms.2010.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mandibular fractures are one the most common maxillofacial injuries. Diagnostic errors, poor surgical technique, healing disorders, or complications may lead to the establishment of posttraumatic mandibular deformities. Nonunion, malunion/malocclusion, or facial asymmetry can be found early during the healing process or as long-term sequelae after the initial mandibular fracture repair. Although occasionally these problems can be solved in a nonsurgical manner, reoperations play an important role in the management of these untoward outcomes. This article discusses the reoperative techniques used for the management of these deformities.
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Affiliation(s)
- Luis G Vega
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Florida, Jacksonville, FL 32209, USA.
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Gaetti-Jardim Júnior E, Fardin AC, Gaetti-Jardim EC, de Castro AL, Schweitzer CM, Avila-Campos MJ. Microbiota associated with chronic osteomyelitis of the jaws. Braz J Microbiol 2010; 41:1056-64. [PMID: 24031586 PMCID: PMC3769776 DOI: 10.1590/s1517-838220100004000025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 12/11/2009] [Accepted: 05/25/2010] [Indexed: 11/22/2022] Open
Abstract
Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37(o)C for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.
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Affiliation(s)
- Elerson Gaetti-Jardim Júnior
- Faculdade de Odontologia de Araçatuba, Departamento de Patologia, Universidade Estadual Paulista , Araçatuba, SP , Brasil ; Laboratório de Anaeróbios, Departamento de Microbiologia, Universidade de São Paulo , São Paulo , Brasil
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