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Vardas E, Adamo D, Canfora F, Kouri M, Delli K, Mignogna MD, Nikitakis N. Impact of COVID-19 Disease on the Development of Osteomyelitis of Jaws: A Systematic Review. J Clin Med 2024; 13:4290. [PMID: 39124558 PMCID: PMC11312479 DOI: 10.3390/jcm13154290] [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: 06/18/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases.
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Affiliation(s)
- Emmanouil Vardas
- Department of Oral Medicine and Pathology and Hospital Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (M.K.); (N.N.)
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples “Federico II”, 80138 Naples, Italy; (F.C.); (M.D.M.)
| | - Federica Canfora
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples “Federico II”, 80138 Naples, Italy; (F.C.); (M.D.M.)
| | - Maria Kouri
- Department of Oral Medicine and Pathology and Hospital Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (M.K.); (N.N.)
| | - Konstantina Delli
- Department of Oral Diseases and Oral and Maxillofacial Surgery, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples “Federico II”, 80138 Naples, Italy; (F.C.); (M.D.M.)
| | - Nikolaos Nikitakis
- Department of Oral Medicine and Pathology and Hospital Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (M.K.); (N.N.)
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Keller E, Clocchiatti S, Rupel K, Ottaviani G, Ratti C, Canton G, Di Lenarda R, Murena L, Biasotto M. Chronic Diffuse Sclerosing Osteomyelitis of the Mandible: The Use of Bisphosphonates as a Treatment for a Rare and Challenging Condition. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:917. [PMID: 38929534 PMCID: PMC11205509 DOI: 10.3390/medicina60060917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Chronic diffuse sclerosing osteomyelitis is a very rare condition, described as a non-suppurative, inflammatory disease of the bone and characterized by a proliferative endosteal reaction, which clinically reveals itself with cyclic pain of the jaw and swelling. We reported two clinical cases, where patients suffered recurrent swelling and pain at the mandible irradiating to the preauricular area, denying any previous trauma or significant medical history. Odontogenic causes were excluded. An initial treatment with antibiotics and NSAIDs temporarily relieved the symptoms without complete resolution, prompting further investigations. After a comprehensive array of diagnostic tools (X-rays, CT scans, scintigraphy, bone biopsy, serum markers), both patients were diagnosed with chronic diffuse sclerosing osteomyelitis of the mandible. Bisphosphonates (clodronate and zolendronate) with different treatment schemes were used to treat the condition, until a full recovery from symptoms was reported. Bisphosphonates could therefore represent an effective option in managing this rare but impactful condition. Further research is warranted to better understand the underlying mechanisms of the disease and to optimize treatment strategies.
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Affiliation(s)
- Edgar Keller
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (E.K.); (K.R.); (R.D.L.); (M.B.)
| | - Susanna Clocchiatti
- Clinica Ortopedica e Traumatologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (S.C.); (C.R.); (G.C.); (L.M.)
| | - Katia Rupel
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (E.K.); (K.R.); (R.D.L.); (M.B.)
| | - Giulia Ottaviani
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (E.K.); (K.R.); (R.D.L.); (M.B.)
| | - Chiara Ratti
- Clinica Ortopedica e Traumatologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (S.C.); (C.R.); (G.C.); (L.M.)
| | - Gianluca Canton
- Clinica Ortopedica e Traumatologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (S.C.); (C.R.); (G.C.); (L.M.)
| | - Roberto Di Lenarda
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (E.K.); (K.R.); (R.D.L.); (M.B.)
| | - Luigi Murena
- Clinica Ortopedica e Traumatologica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34100 Trieste, Italy; (S.C.); (C.R.); (G.C.); (L.M.)
| | - Matteo Biasotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (E.K.); (K.R.); (R.D.L.); (M.B.)
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Kumar T, Dutta RR, Singh A, Mehendale AM, Charan Pahari K. The Rarity of Maxillary Osteomyelitis: Insights From a Unique Case Report. Cureus 2024; 16:e61202. [PMID: 38939302 PMCID: PMC11208756 DOI: 10.7759/cureus.61202] [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] [Received: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Maxillary osteomyelitis is a rare bone infection and is rarer to come across with the advent of advanced antibiotic therapies. It is often linked to immunocompromised conditions, namely diabetes mellitus, cancer, and chronic alcoholism, as they increase the chances of developing osteomyelitis. We present a rare case of maxillary osteomyelitis along with an infraorbital abscess in a 32-year-old male patient with uncontrolled diabetes. The patient complained of dental pain, facial swelling, and visual disturbances. The patient was managed with sequestrectomy along with curettage, incision, and drainage of orbital abscess. The patient responded well to surgery and had no complications post-surgery. As radiographic signs may present late, the authors aim to highlight the significance of thorough clinical examination and good patient history. Prompt radical treatment is necessary to avoid any severe consequences.
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Affiliation(s)
- Tanishq Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Rajoshee R Dutta
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Arihant Singh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ashok M Mehendale
- Preventive Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Grün P, Pfaffeneder-Mantai F, Schneider B, Meier M, Bytyqi D, Bandura P, Turhani D. Can jaw bone healed from chronic sclerosing osteomyelitis be considered healthy when planning dental implants? Case report with 20-year follow-up. Ann Med Surg (Lond) 2024; 86:2266-2276. [PMID: 38576989 PMCID: PMC10990345 DOI: 10.1097/ms9.0000000000001826] [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: 12/17/2023] [Accepted: 02/02/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Extraction of mandibular third molars can lead to complications such as chronic sclerosing osteomyelitis (CSO), an inflammatory bone marrow disease that tends to progress. CSO involves the cortical plates and often the periosteal tissues and is caused by a variety of microorganisms, including Corynebacterium spp. The treatment of chronic osteomyelitis (CO) and CSO remains challenging, as there is no universal treatment protocol. This case report investigated whether jaw bone that has healed from chronic sclerosing osteomyelitis can be considered healthy bone when planning dental implants. Case presentation A 21-year-old Caucasian woman developed CO and CSO after third molar surgery. Clinical discussion A combination of alveolar ridge bone resection, extraction of teeth 47-32, and long-term specific antibiotic therapy against Corynebacterium spp. was administered. An attempt at preprosthetic alveolar ridge reconstruction with an anterior superior iliac crest bone graft resulted in graft failure and the patient refused further harvesting procedures. Implantation in the intraforaminal zone also resulted in the loss of two implants after loading. Finally, inferior alveolar nerve transposition resulted in the successful reimplantation of two implants, which were fully functional almost 11 years later. Conclusion This case report presents the treatment history of this patient. With a longitudinal observation period of greater than 20 years, the results of this case demonstrate the successful treatment of bone with CO, CSO, and Corynebacterium spp. infection. Following the removal of infected bone, radical debridement, and long-term antibiotic therapy, bone health was restored.
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Affiliation(s)
- Pascal Grün
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
| | - Florian Pfaffeneder-Mantai
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
- Division for Chemistry and Physics of Materials, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | | | - Marius Meier
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
| | - Ditjon Bytyqi
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
| | - Patrick Bandura
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
| | - Dritan Turhani
- Center for Oral and Maxillofacial Surgery, Department of Dentistry
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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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DuVal M, Alkhraisat MH. Adjunctive Plasma Rich in Growth Factors in the Treatment of Osteomyelitis and Large Odontogenic Cysts Prior to Successful Implant Rehabilitation: Case Report. Dent J (Basel) 2023; 11:184. [PMID: 37623280 PMCID: PMC10453440 DOI: 10.3390/dj11080184] [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: 06/15/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Osteomyelitis of the jaws presents a clinical challenge to conventional treatment, often requiring multiple surgical interventions resulting in significant deformity and presenting significant problems to satisfactory rehabilitation. While benign odontogenic cysts, such as the radicular cyst, are generally predictably treated, they can cause significant localized bone destruction and thus can present significant problems in satisfactory rehabilitation. In this case report, patients were treated combining conventionally appropriate surgical debridement and oral antibiotics with adjunctive plasma rich in growth factors (PRGF). Patients showed a complete soft tissue and osseous regeneration to their pre-pathologic state, with successful implant rehabilitation. PRGF appears to be highly successful in minimizing or eliminating osseous deformities normally associated with conventional treatment of osteomyelitis of the jaw and treatment of large odontogenic cysts. Future trials must be performed to confirm these results in comparison to controls using conventional treatment alone.
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Affiliation(s)
- Marc DuVal
- Department of Dentistry, McGill University, Montreal, QC H3A 0C7, Canada
- Montreal Jewish General Hospital, Department of Dentistry and Oral and Oral and Maxillofacial Surgery, Montreal, QC H3T 1E2, Canada
- Santa Cabrini Hospital, Department of Surgery, Division of Plastics, Montreal, QC H1T 1P7, Canada
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7
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Pappachan B, Agrawal R. Osteomyelitis in Jaw of Children and Young Adults. J Maxillofac Oral Surg 2023. [DOI: 10.1007/s12663-023-01852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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8
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Nilesh K, Patil P, Patil D, Patil M. Non-radiation and non-drug-induced maxillary osteomyelitis: Study of underlying risk factors, presentation, management and treatment outcomes. Med J Armed Forces India 2022; 78:S145-S151. [PMID: 36147398 PMCID: PMC9485758 DOI: 10.1016/j.mjafi.2020.06.008] [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: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background Osteomyelitis of the jawbone is mostly secondary to radiation exposure or bone remodelling drugs, with the mandible being commonly involved. Maxillary osteomyelitis risk is low owing to its high vascularity. This study was undertaken to evaluate risk factors, presentation, management and outcomes of maxillary osteomyelitis caused due to reasons other than irradiation and bone remodelling drugs. Methods Patient records diagnosed with maxillary osteomyelitis were evaluated for demographic details, risk factors, clinical presentation, radiological features, treatment performed and outcomes. Results In 38 patients with non-irradiated and non-drug-induced osteomyelitis, 13 involved the maxilla, seven were localized to the posterior maxilla and 10 showed paranasal sinus involvement. Dissemination to the cavernous sinus and cerebral spread was seen in one. Clinical findings included oroantral communication, pain and draining sinus. Imaging showed diffuse bone destruction areas with or without evidence of bony sequestrum. The most common systemic risk factor was diabetes mellitus. Maxillary osteomyelitis was associated with tooth extraction in eight cases. Surgical management included debridement, sequestrectomy, functional endoscopic sinus surgery, maxillectomy and reconstruction of soft tissue defect with local and regional flaps. Complete recovery was seen in 11 patients. Mortality was seen in two patients with mucormycosis having disseminated infection. Conclusion Compared with previous literature, a relatively higher ratio of maxillary involvement was reported. Diabetes mellitus was the most common risk factor, followed by osteopetrosis and tooth extraction. Osteomyelitis secondary to mucormycosis in immunocompetent patients was relatively localized and gave favourable response to management compared with patients with diabetes mellitus.
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Affiliation(s)
- Kumar Nilesh
- Professor (Oral & Maxillofacial Surgery), School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
| | - Pankaj Patil
- Senior Lecturer (Oral & Maxillofacial Surgery), School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
| | - Digvijay Patil
- Assistant Professor (Surgical Oncology), KIMSDU, Karad, Maharashtra, India
| | - Monica Patil
- Resident (Oral & Maxillofacial Surgery), School of Dental Sciences, KIMSDU, Karad, Maharashtra, India
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9
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Johnston DT, Phero JA, Hechler BL. The Necessity of Antibiotics in the Management of Surgically Treated Mandibular Osteomyelitis: A Systematic Review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:11-23. [PMID: 35863960 DOI: 10.1016/j.oooo.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mandibular osteomyelitis remains an incompletely understood entity, and treatment of its various presentations remains diverse. The purpose of this study was to review the necessity of antibiotic therapy after surgical treatment of mandibular osteomyelitis. STUDY DESIGN A systematic review of published articles on surgical management of mandibular osteomyelitis with or without postoperative antibiotic therapy was performed to answer the question, "Does the use of postoperative antibiotics compared with surgery alone alter the success rate in treating mandibular osteomyelitis?" The most recent evidence was sought by searching PubMed, Embase, and Scopus databases. Article appraisal was performed by 2 reviewers. RESULTS Forty-five articles were found that met the inclusion criteria, with all studies being retrospective cohort or case series designs. Only 13 articles used Zurich classification designations of acute osteomyelitis, secondary chronic osteomyelitis, or primary chronic osteomyelitis, and the general heterogeneity of these articles made comparison difficult. No study made an intentional statistical assessment of various antibiotic protocols. CONCLUSIONS Limited evidence suggested that resection may have better success rates than other forms of surgical intervention, regardless of antibiotic therapy. This systematic review questions the perceived necessity of intermediate- or long-term antibiotic therapy in the management of mandibular osteomyelitis after surgical resection.
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10
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Wang KY, Liu WC, Chen CF, Chen LW, Chen HC, Yang KC. Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction. J Reconstr Microsurg 2021; 37:524-529. [PMID: 33517570 DOI: 10.1055/s-0040-1722647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. METHODS This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998-2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. RESULTS Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). CONCLUSION Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.
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Affiliation(s)
- Kuan-Ying Wang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,Division of Plastic Surgery and Reconstructive Surgery, Chuanghua Christian Hospital, Chuanghua, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Wen-Chung Liu
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Feng Chen
- Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,Dental Laboratory Technology, Shu Zen College of Medicine and Management, Kaohsiung, Taiwan, Republic of China
| | - Lee-Wei Chen
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Hung-Chi Chen
- International Medical Service Center of China Medical University Hospital, Taichung City, Taiwan, Republic of China.,Department of Plastic Surgery, China Medical University, Taichung City, Taiwan, Republic of China
| | - Kuo-Chung Yang
- Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Kusumoto J, Uda A, Kimura T, Furudoi S, Yoshii R, Matsumura M, Miyara T, Akashi M. Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis. BMC Oral Health 2021; 21:20. [PMID: 33413262 PMCID: PMC7791648 DOI: 10.1186/s12903-020-01367-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. METHODS The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. RESULTS After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). CONCLUSIONS This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.
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Affiliation(s)
- Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan.
| | - Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Kimura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
- Department of Oral Surgery, Konan Medical Center, Kobe, Hyogo, 658-0064, Japan
| | - Ryosuke Yoshii
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Megumi Matsumura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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12
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Gallarate M, Chirio D, Chindamo G, Peira E, Sapino S. Osteomyelitis: Focus on Conventional Treatments and Innovative Drug Delivery Systems. Curr Drug Deliv 2020; 18:532-545. [PMID: 32933461 DOI: 10.2174/1567201817666200915093224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
Osteomyelitis is a bone marrow infection which generally involves cortical plates and which may occur after bone trauma, orthopedic/maxillofacial surgery or after vascular insufficiency episodes. It mostly affects people from the Third World Countries, the elderly and patients affected by systemic diseases e.g. autoimmune disorders, AIDS, osteoporosis and microvascular disease. The highest percentage of osteomyelitis cases (almost 75%) is caused by Staphylococcus spp., and in particular by Staphylococcus aureus (more than 50%). The ideal classification and the diagnosis of osteomyelitis are two important tools which help the physicians to choose the best therapeutic strategies. Currently, common therapies provide an extensive debridement in association with intravenous administration of antibiotics (penicillin or clindamycin, vancomycin and fluoroquinolones among all for resistant microorganisms), to avoid the formation of sequestra. However, conventional therapeutic approach involves several drawbacks like low concentration of antibiotics in the infected site, leading to resistance and adverse effects due to the intravenous administration. For these reasons, in the last years several studies have been focused on the development of drug delivery systems such as cements, beads, scaffolds and ceramics made of hydroxyapatite (HA), calcium phosphate (CaP) and β-tricalcium phosphate (β-TCP) which demonstrated to be biocompatible, poorly toxic and capable to allow osteointegration and a prolonged drug release. The aim of this review is to provide a focus on current therapies and latest developed drug delivery systems with particular attention on those based on CaP and its derivatives, hoping that this work could allow further direction in the field of osteomyelitis.
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Affiliation(s)
- Marina Gallarate
- Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy
| | - Daniela Chirio
- Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy
| | - Giulia Chindamo
- Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy
| | - Elena Peira
- Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy
| | - Simona Sapino
- Department of Drug Science and Technology, University of Turin, via P. Giuria 9, Turin, 10125, Italy
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A comprehensive review of bacterial osteomyelitis with emphasis on Staphylococcus aureus. Microb Pathog 2020; 148:104431. [PMID: 32801004 DOI: 10.1016/j.micpath.2020.104431] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
Osteomyelitis, a significant infection of bone tissue, gives rise to two main groups of infection: acute and chronic. These groups are further categorized in terms of the duration of infection. Usually, children and adults are more susceptible to acute and chronic infections, respectively. The aforementioned groups of osteomyelitis share almost 80% of the corresponding bacterial pathogens. Among all bacteria, Staphylococcus aureus (S. aureus) is a significant pathogen and is associated with a high range of osteomyelitis symptoms. S. aureus has many strategies for interacting with host cells including Small Colony Variant (SCV), biofilm formation, and toxin secretion. In addition, it induces an inflammatory response and causes host cell death by apoptosis and necrosis. However, any possible step to take in this respect is dependent on the conditions and host responses. In the absence of any immune responses and antibiotics, bacteria actively duplicate themselves; however, in the presence of phagocytic cell and harassing conditions, they turn into a SCV, remaining sustainable for a long time. SCV is characterized by notable advantages such as (a) intracellular life that mediates a dam against immune cells and (b) low ATP production that mediates resistance against antibiotics.
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Development of osteomyelitis following dental abscesses-influence of therapy and comorbidities. Clin Oral Investig 2020; 25:1395-1401. [PMID: 32638128 DOI: 10.1007/s00784-020-03447-6] [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] [Received: 04/23/2020] [Accepted: 07/03/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Bacterial osteomyelitis of the jaw is a severe disease potentially requiring extensive surgical treatment. We have evaluated the incidence rates of bacterial osteomyelitis following dental abscessation associated with primary or secondary tooth extraction. MATERIALS AND METHODS A retrospective cohort study was designed and included patients with dental abscesses and surgical treatment including the extraction of focus teeth. Patients were either treated with primary removal during acute infection or secondary delayed extraction within an infection-free interval. The primary outcome variable was the occurrence of bacterial osteomyelitis following the abscess. Secondary outcomes were the influence of general disease, antibiotic therapy, and surgical technique. RESULTS One hundred nine patients were enrolled in the study; 4 patients (3.7%) developed osteomyelitis. Primary tooth extraction was performed on all these patients (p = 0.017). Significant associations of diabetes (p = 0.001), the use of clindamycin (p = 0.025), and transcutaneous incision (p = 0.017) with the incidence of osteomyelitis were detected. CONCLUSIONS More severe infections may be associated with a higher risk for the development of osteomyelitis following dental abscesses. A history of diabetes and clindamycin therapy might form further predisposing risk factors. Because of the low incidence and the small case number, our data need to be interpreted carefully. CLINICAL RELEVANCE Osteomyelitis of the jaw is a rare but severe disease that may require extensive therapy and that impairs the quality of life of affected patients. The evaluation of risk factors to enable further reduction of incidence is therefore urgently required.
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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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Anehosur V, Agrawal SM, Joshi VK, Anand J, Krishnamuthy K, Kumar N. Incidence and Treatment Protocol for Maxillofacial Fungal Osteomyelitis: A 12-Year Study. J Oral Maxillofac Surg 2019; 77:2285-2291. [DOI: 10.1016/j.joms.2019.06.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/29/2019] [Accepted: 06/29/2019] [Indexed: 11/29/2022]
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Infected Cemento-Osseous Dysplasia: Analysis of 66 Cases and Literature Review. Head Neck Pathol 2019; 14:173-182. [PMID: 31011984 PMCID: PMC7021850 DOI: 10.1007/s12105-019-01037-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study was to describe a series with 66 cases of infected cemento-osseous dysplasia (COD) and to discuss the demographic distribution, clinicoradiographic features and treatment of this condition. A study looking back on the diagnoses made at a single Brazilian centre within a 28-year timeframe was performed. A literature review with searches across five databases was also conducted to identify reports on osteomyelitis/infected COD. Descriptive and statistical analyses were performed. The case series study showed a female/male ratio of 21:1. Affected individuals' mean age was 57.4 years. Mandible was the most affected site (95.5%) and florid subtype was the most frequent infected COD (62.1%). Tooth extraction was the main factor associated with the development of infection associated within a COD lesion. The literature review retrieved 30 studies reporting 46 cases of this condition. Asian women in their 40 s and 50 s were more affected. Surgery for removal/curettage of necrotic bone was acknowledged as an appropriate approach to the treatment of this infection. The clinicodemographic data of the study were similar to data collected across the literature. Clinicians, maxillofacial surgeons and oral rehabilitation providers should be alert to the diagnosis of COD, since infection is a frequent complication whose management is challenging.
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Sandhu S, Villa A, Treister NS. A mobile molar with furcation involvement. J Am Dent Assoc 2019; 150:972-978. [PMID: 30898305 DOI: 10.1016/j.adaj.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/07/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022]
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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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Arani R, Shareef SNHA, Khanam HMK. Mucormycotic Osteomyelitis Involving the Maxilla: A Rare Case Report and Review of the Literature. Case Rep Infect Dis 2019; 2019:8459296. [PMID: 30805232 PMCID: PMC6362471 DOI: 10.1155/2019/8459296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/19/2018] [Accepted: 11/04/2018] [Indexed: 11/17/2022] Open
Abstract
Osteomyelitis is an inflammatory process of bone and marrow contents. These changes in bone are primarily seen in soft tissue followed by calcified tissue. It is an opportunistic infection due to the complication of some other conditions rendering the host susceptible to disease. Consequences of this infection range from draining tract to malignant transformation. Various etiological factors are involved in origin of the disease; among them, fungal origin is rare. Specific feature in fungal osteomyelitis is the involvement of maxillary sinus with a complaint of sinusitis associated with diabetes mellitus. Here, we discuss a case of osteomyelitis with fungal infection involving the maxilla. The patient is under medication for the past five years due to diabetes.
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Affiliation(s)
- Rajesh Arani
- Dept. of Oral Pathology and Microbiology, G.Pulla Reddy Dental College and Hospital, Kurnool, Andhra Pradesh, India
| | | | - H. M. Khuthija Khanam
- Department of Restorative and Prosthetic Dental Sciences, Dar Al Uloom University, Riyadh, Saudi Arabia
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Chronic Candida osteomyelitis of hard palate and nose: A diagnostic quandary. Med Mycol Case Rep 2019; 24:1-4. [PMID: 30733914 PMCID: PMC6357845 DOI: 10.1016/j.mmcr.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/30/2022] Open
Abstract
Candida induced osteomyelitis is infrequent. There is scarcity of literature on this entity in maxillofacial region and thus there is possibility to mismanage such cases. We are presenting a case of chronic maxillofacial Candida tropicalis osteomyelitis causing palatal and septal perforation with saddle nose deformity in a young lady with commencement and progression of disease process over two pregnancies. Diagnosis was established by histopathology and repeated isolation on culture. Debridement followed by adequate antifungal therapy instituted.
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Abstract
Osteomyelitis is an inflammation of bone marrow with a tendency for progression, involving the cortical plates and often periosteal tissues, with most cases occurring after trauma to bone or bone surgery or secondary to vascular insufficiency. Antimicrobial therapy and surgical débridement are the primary modalities of osteomyelitis treatment, although often it is associated with a prolonged course, requiring a large commitment between patient and clinician as well as sizable health care costs. Despite surgical and chemotherapeutic advancements, osteomyelitis remains difficult to treat, and no universally accepted protocol for treatment exists.
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Haeffs TH, Scott CA, Campbell TH, Chen Y, August M. Acute and Chronic Suppurative Osteomyelitis of the Jaws: A 10-Year Review and Assessment of Treatment Outcome. J Oral Maxillofac Surg 2018; 76:2551-2558. [PMID: 30509394 DOI: 10.1016/j.joms.2018.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To review cases of suppurative osteomyelitis of the jaws treated at the Massachusetts General Hospital (Boston, MA) over a 10-year period, evaluate specifics of disease presentation, and answer the clinical question: are there identifiable variables associated with treatment outcome? MATERIALS AND METHODS A retrospective cohort study was completed using patients treated for suppurative osteomyelitis of the jaws at the Massachusetts General Hospital from April 2006 to October 2016. Inclusion criteria were a diagnosis of suppurative osteomyelitis of the jaw, age older than 18 years, and complete medical records. Patients with nonsuppurative disease, radiation history, or antiresorptive exposure were excluded. Candidate variables included demographic information, medical and dental history, presenting signs and symptoms, and radiologic and laboratory findings. The outcome variable was successful treatment, defined as resolution of symptoms and radiographic evidence of healing after initial treatment. Appropriate statistical analyses were performed with significance set a P value less than .05. RESULTS Forty-two patients met the inclusion criteria. Mean age was 53 years (range, 20 to 80 yr) and 26 were women (62%). Common comorbidities included cardiovascular disease (52%), tobacco use (45%), and psychiatric disorders (45%). Pain (90%), swelling (86%), and neurosensory change (50%) were the most common findings. Common microbacterial isolates included Streptococcus milleri (74%) and coagulase-negative Staphylococcus species (43%), which showed marked antibiotic resistance. Surgical debridement was the most common intervention (93%). Successful treatment was found in 86%. Of 6 persistent cases, 4 resolved with a second debridement and continued antibiotics and 2 required resection. Increased white blood cell (WBC) count at presentation (P = .005) and associated psychiatric diagnoses (P = .037) were statistically associated with unsuccessful initial treatment. CONCLUSION The results of this study indicate that antibiotic resistance is commonly encountered in this patient population, although it was not associated with unsuccessful outcome. Patients presenting with increased WBC count and concurrent psychiatric comorbidities required protracted treatment.
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Affiliation(s)
- Tyler H Haeffs
- Predoctoral Student, Harvard School of Dental Medicine, Boston, MA
| | | | - Tiffany H Campbell
- Resident, Department of Dentistry, Massachusetts General Hospital, Boston, MA
| | - Youbai Chen
- Master's Program in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Meredith August
- Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
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Bertrand K, Lamy B, De Boutray M, Yachouh J, Galmiche S, Leprêtre P, de Champfleur NM, Reynes J, Le Moing V, Morquin D. Osteomyelitis of the jaw: time to rethink the bone sampling strategy? Eur J Clin Microbiol Infect Dis 2018. [PMID: 29516234 DOI: 10.1007/s10096-018-3219-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the relevance of a new method designed to avoid salivary contamination during bone sampling in order to improve microbiological analysis and clinical decision-making. We reviewed medical and microbiological data of patients with a suspected OJ based on clinical and/or CT-scan signs and at least one bone sample made for microbiological analysis. During the study period, a new procedure for intraoral bone sampling was elaborated by surgeons and infectious diseases specialists authoring this article (based on stratified samples, cleaning of the surgical site and change of instruments between each sample). A comparison of the microbiological analyses between the two procedures was performed. From 2012 to 2017, 56 patients were included. Median age was 58 years (11-90), sex ratio: 1.24. Main risk factors were having a dental disease (n = 24) or cancer (n = 21). Nineteen patients with the new sample procedure were compared to 37 patients with standard procedure, especially non-cancer patients (n = 16 and 19, respectively). With the new procedure, a median of 3 (1-7) microorganisms per sample was recovered, vs. 7 (1-14) with the former (p < 0.001), a significant decrease of the microbial density was observed for all types of microbes, especially in deeper samples and cultures were more frequently sterile. The way sampling is managed deeply influences microbiological analysis. This strategy facilitates the distinction between pathogens and contaminants and should constitute the first step toward an evidence-based antimicrobial strategy for OJ.
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Affiliation(s)
- Kevin Bertrand
- Infectious Diseases Department, Perpignan Hospital, Perpignan, France.
| | - Brigitte Lamy
- Bacteriology Department, Nice Teaching Hospital, Nice, France
| | - Marie De Boutray
- Maxillofacial Department, Montpellier Teaching Hospital, Montpellier, France
| | - Jacques Yachouh
- Maxillofacial Department, Saint-Roch Clinic, Montpellier, France
| | - Sophie Galmiche
- Maxillofacial Department, Montpellier Teaching Hospital, Montpellier, France
| | - Pierre Leprêtre
- Medical Imaging Department, Montpellier Teaching Hospital, Montpellier, France
| | | | - Jacques Reynes
- Infectious Diseases Department, Montpellier Teaching Hospital, Montpellier, France.,UMI 233 TransVIHMI, University of Montpellier, Montpellier, France
| | - Vincent Le Moing
- Infectious Diseases Department, Montpellier Teaching Hospital, Montpellier, France.,UMI 233 TransVIHMI, University of Montpellier, Montpellier, France
| | - David Morquin
- Infectious Diseases Department, Montpellier Teaching Hospital, Montpellier, France.,UMI 233 TransVIHMI, University of Montpellier, Montpellier, France
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Chatelain S, Lombardi T, Scolozzi P. Streptococcus anginosus Dental Implant-Related Osteomyelitis of the Jaws: An Insidious and Calamitous Entity. J Oral Maxillofac Surg 2018; 76:1187-1193. [PMID: 29425755 DOI: 10.1016/j.joms.2018.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/17/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE We analyzed the data from a series of patients with dental implant-related suppurative osteomyelitis of the jaws (DIOMJ) due to Streptococcus anginosus. PATIENTS AND METHODS The medical records of all patients seen for osteomyelitis of the jaws from 2011 to 2016 were reviewed. The primary outcome variable was Streptococcus anginosus DIOMJ. Other variables included age, gender, smoking habits, associated comorbidities, dental implant localization, type of osteomyelitis, delay between dental implant placement and DIOMJ, microbiologic examination and antibiogram, antibiotherapy, type of surgery, and final outcome. Cases from previous reports of DIOMJ were also analyzed for comparison. Finally, descriptive statistics were computed. RESULTS A total of 26 patients had jaw osteomyelitis; in 6 patients (26%), jaw osteomyelitis had developed after dental implant placement. S. anginosus was found in 5 patients and Escherichia coli in 1. The osteomyelitis was located in the mandible and associated with a deep neck abscess in all cases. All the patients were women and were either smokers or had comorbidities affecting bone metabolism. In all 6 cases, the dental implants were removed, and several surgical debridement procedures (≥2) and prolonged antibiotherapy (average of 6 months) were needed. Of the 6 patients, 3 required a radical surgical reconstructive procedure with partial resection and bone grafting. CONCLUSIONS The present study demonstrated that Streptococcus anginosus DIOMJ is a particularly aggressive form of osteomyelitis that has a propensity to develop in the mandible of women in their 60s who are either smokers or have comorbidities.
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Affiliation(s)
- Sybille Chatelain
- Resident, Division of Oral and Maxillofacial Surgery, Unit of Oral Surgery and Implantology, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Tommaso Lombardi
- Head, Division of Oral and Maxillofacial Surgery, Unit of Oral and Maxillofacial Medicine and Pathology, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland.
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Completely exposed nasal bone. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:402-404. [PMID: 28822758 DOI: 10.1016/j.jormas.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 11/21/2022]
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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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Qaisi M, Montague L. Bone Margin Analysis for Osteonecrosis and Osteomyelitis of the Jaws. Oral Maxillofac Surg Clin North Am 2017; 29:301-313. [DOI: 10.1016/j.coms.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Andre CV, Khonsari RH, Ernenwein D, Goudot P, Ruhin B. Osteomyelitis of the jaws: A retrospective series of 40 patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:261-264. [PMID: 28502763 DOI: 10.1016/j.jormas.2017.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The caseload of jaw osteomyelitis seem to have decreased considerably over the last fifty years thanks to the progress of oral hygiene, the appearance and the use of antibiotics, and early screening. 'Limited osteitis' remains frequent in general practice (alveolitis after dental extraction), but osteomyelitis is much rarer as evidenced by the lack of current literature and the low number of reported patients in the published series. The aim of this study was to analyze retrospectively all the cases of maxillo-mandibular osteomyelitis treated in a large academic department of Stomatology and Maxillofacial Surgery over a period of 6 years and to compare the results to data from the literature. MATERIAL AND METHOD All patients diagnosed with maxillo-mandibular osteomyelitis by one of the staff surgeons between January 2009 and December 2015 was included. An epidemiological record (sex, age, ethnic background, risk factors, clinical, origin of disease, imaging and biology, treatments and progression) were collected for each patient. Osteomyelitis cases were classified according to the Zurich Classification System. Results were compared to data from the literature. RESULTS Forty patients were retained. Three presented acute osteomyelitis, 26 secondary chronic osteomyelitis and 11 a primary chronic osteomyelitis. Osteomyelitis affected predominantly the mandible (87%). Dental origin was found in 90% of cases. Nine patients (22.5%) recovered and 29 (90%) were clinically improved. Ten of the 11 patients with primary chronic osteomyelitis were improved. DISCUSSION This cohort study is one of the largest series currently available and presents results comparable to those of the literature of the last 25 years.
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Affiliation(s)
- C-V Andre
- Department of stomatology and maxillofacial surgery, Pierre-et-Marie-Curie university Paris-6, Pitié-Salpêtrière hospital, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - R-H Khonsari
- Department of stomatology and maxillofacial surgery, Pierre-et-Marie-Curie university Paris-6, Pitié-Salpêtrière hospital, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | | | - P Goudot
- Department of stomatology and maxillofacial surgery, Pierre-et-Marie-Curie university Paris-6, Pitié-Salpêtrière hospital, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - B Ruhin
- Department of stomatology and maxillofacial surgery, Pierre-et-Marie-Curie university Paris-6, Pitié-Salpêtrière hospital, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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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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Use of Vancomycin-Impregnated Calcium Sulfate in the Treatment of Osteomyelitis of the Jaw. J Oral Maxillofac Surg 2017; 75:119-128. [DOI: 10.1016/j.joms.2016.06.178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022]
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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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Park J, Myoung H. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2016; 42:215-20. [PMID: 27595089 PMCID: PMC5009196 DOI: 10.5125/jkaoms.2016.42.4.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 11/21/2022] Open
Abstract
In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.
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Affiliation(s)
- Joonhyoung Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.; Dental Research Institute, Seoul National University, Seoul, Korea
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Tsuchiya S, Sugimoto K, Omori M, Matsuda R, Fujio M, Hibi H. Mandibular osteomyelitis implicated in infliximab and periapical periodontitis: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jauhar P, Handley T, Hammersley N. A Pathological Fracture of the Mandible due to Osteomyelitis following a Full Dental Clearance. ACTA ACUST UNITED AC 2016; 43:168-70, 173, 175. [PMID: 27188132 DOI: 10.12968/denu.2016.43.2.168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.
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36
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Shah SR, Tatara AM, Lam J, Lu S, Scott DW, Bennett GN, van den Beucken JJJP, Jansen JA, Wong ME, Mikos AG. Polymer-Based Local Antibiotic Delivery for Prevention of Polymicrobial Infection in Contaminated Mandibular Implants. ACS Biomater Sci Eng 2016; 2:558-566. [DOI: 10.1021/acsbiomaterials.5b00545] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarita R. Shah
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Alexander M. Tatara
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Johnny Lam
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - Steven Lu
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
| | - David W. Scott
- Department
of Statistics, Rice University, Houston, Texas 77251, United States
| | - George N. Bennett
- Department
of BioSciences, Rice University, Houston, Texas 77005, United States
| | | | - John A. Jansen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark E. Wong
- University of Texas Health Science Center at Houston, Houston, Texas 77030, United States
| | - Antonios G. Mikos
- Department
of Bioengineering, Rice University, Houston, Texas 77030, United States
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Urs AB, Singh H, Mohanty S, Sharma P. Fungal osteomyelitis of maxillofacial bones: Rare presentation. J Oral Maxillofac Pathol 2016; 20:546. [PMID: 27721629 PMCID: PMC5051312 DOI: 10.4103/0973-029x.190966] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteomyelitis is defined as inflammation of the medullary cavities, haversian system and adjacent cortex of bone. Osteomyelitis involving maxilla is quite rare when compared to that of mandible. Fungal osteomyelitis is very rarely seen and documented in the maxillofacial area. It is devastating to patients if it is invasive in nature. A prospective study was undertaken from December 2011 to December 2013. Biopsied hard tissue bits were decalcified and sections were stained with H&E, periodic acid Schiff and Grocott methenamine silver. Culture sensitivity was carried out in all cases. Surgical intervention followed by antifungal therapy was advocated to treat the patients. The current series showed five cases of fungal osteomyelitis which included candidal osteomyelitis, aspergillosis and mucormycosis with slight predominance of maxilla over mandible. Osteomyelitis of facial bones needs to be investigated thoroughly as there is no difference in clinical presentation between bacterial and fungal osteomyelitis. The diagnostic workup with biopsy and culture sensitivity helps to identify the pathogen at the earliest. Appropriate antifungal treatment needs to be advocated for successful treatment.
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Affiliation(s)
- Aadithya B Urs
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Hanspal Singh
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sujata Mohanty
- Department of Oral Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Pankaj Sharma
- Department of Oral Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Huh S, Lee CY, Ohe JY, Lee JW, Choi BJ, Lee BS, Kwon YD. Chronic maxillary sinusitis and diabetes related maxillary osteonecrosis: a case report. J Korean Assoc Oral Maxillofac Surg 2015; 41:332-7. [PMID: 26734561 PMCID: PMC4699935 DOI: 10.5125/jkaoms.2015.41.6.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/07/2022] Open
Abstract
Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment.
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Affiliation(s)
- Suk Huh
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Chae-Yoon Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Joo-Young Ohe
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Jung-Woo Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Byung-Jun Choi
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Baek-Soo Lee
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, Kyung Hee University School of Dentistry, Seoul, Korea
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39
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Berglund C, Ekströmer K, Abtahi J. Primary Chronic Osteomyelitis of the Jaws in Children: An Update on Pathophysiology, Radiological Findings, Treatment Strategies, and Prospective Analysis of Two Cases. Case Rep Dent 2015; 2015:152717. [PMID: 26435856 PMCID: PMC4575997 DOI: 10.1155/2015/152717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022] Open
Abstract
Objective. Primary chronic osteomyelitis (PCO) of the jaws in children is associated with pain, trismus, and swelling. In children, temporomandibular joint involvement is rare and few studies have been published due to the relatively low incidence. This paper presents two cases of mandibular PCO in children with the involvement of the collum mandibulae. In addition, a review of the literature regarding demographic data, histological, radiological, and laboratory findings, and treatment strategies of PCO was also performed. Material and Methods. Prospective analyses of two PCO cases. A PubMed search was used and the articles were sorted according to their corresponding key area of focus. Results. Review of the literature revealed twenty-four cases of PCO with two cases of mandibular condyle involvement. The mean age was 18 years; the male to female ratio was 1 : 3. Most of the patients were treated with anti-inflammatory drugs in combination with decortication. Clinical recurrence was seen in 7 cases. Conclusion. A combination of anti-inflammatory drugs and surgical intervention appears to be the first choice of treatment. However, surgical removal of necrotic tissue adjacent to collum mandibulae has its limitations in children. Further investigations are of utmost importance in order to increase our knowledge and understanding of this disease.
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Affiliation(s)
- Caroline Berglund
- Department of Oral & Maxillofacial Surgery, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Karin Ekströmer
- Department of Radiology, Mälarsjukhuset Eskilstuna Hospital, Sweden
| | - Jahan Abtahi
- Department of Oral & Maxillofacial Surgery, Linköping University Hospital, 581 85 Linköping, Sweden
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40
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Bell CM, Soukup JW. Histologic, Clinical, and Radiologic Findings of Alveolar Bone Expansion and Osteomyelitis of the Jaws in Cats. Vet Pathol 2015; 52:910-8. [DOI: 10.1177/0300985815591079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to characterize clinical, radiologic, and histologic patterns of alveolar bone expansion and osteomyelitis in cats. Based on case materials submitted as surgical biopsy specimens, alveolar bone pathology was diagnosed in 28 cats. These cats had a total of 37 oral lesions with clinical and radiologic changes that involved bone and/or teeth, including periodontitis, bone expansion, tooth resorption, and/or chronic osteomyelitis; 32 lesions were evaluated by histopathology. Canine teeth were affected in 19 cats (27 affected teeth), with bilateral lesions in 5 (26.3%) cats. The caudal premolar and/or molar regions were affected in 10 cats (10 affected sites). All biopsy sites evaluated by a review of clinical images and/or radiographs had evidence of periodontitis. Clinical photographs showed expansion of alveolar bone in 13 of 16 (81%) biopsy sites evaluated. Radiologically, rarifying osseous proliferation of alveolar bone was seen at 26 of 27 (96%) biopsy sites, and tooth resorption occurred at 15 of 18 (83%) sites. Histologically, the tissue samples from canine sites had compressed trabeculae of mature remodeled bone, loose fibrous stroma with paucicellular inflammation, and mild proliferation of woven bone. Tissue samples from the premolar/molar biopsy sites were often highly cellular with mixed lymphoplasmacytic and chronic suppurative inflammation, ulceration with granulation tissue, and robust proliferation of woven bone. Alveolar bone expansion and osteomyelitis in cats occurs in conjunction with periodontal inflammation and frequently with tooth resorption.
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Affiliation(s)
- C. M. Bell
- Center for Comparative Oral and Maxillofacial Pathology, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - J. W. Soukup
- Center for Comparative Oral and Maxillofacial Pathology, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
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41
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Yadav S, Malik S, Mittal HC, Puri P. Chronic suppurative osteomyelitis of posterior maxilla: A rare presentation. J Oral Maxillofac Pathol 2015; 18:481. [PMID: 25949012 PMCID: PMC4409202 DOI: 10.4103/0973-029x.151364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/13/2015] [Indexed: 11/04/2022] Open
Abstract
Thin cortical bone rich in vascularity makes the maxilla scarcely vulnerable to osteomyelitis as compared to mandible. Moreover, the introduction of newer antibiotics, understanding of pathogenesis and improved medical support lead to reduction in incidence of osteomyelitis. Local factors like continuous irritation, smoking and suppressed immune system contributes to the occurrence of suppurative osteomyelitis. We hereby, report an exceptional case of chronic suppurative osteomyelitis of posterior maxilla in a 42-year-old healthy male who was managed successfully by combination of antibiotics, surgical sequestrectomy and debridement.
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Affiliation(s)
- Sunil Yadav
- Department of Dental Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Sunita Malik
- Department of Dental Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Hitesh C Mittal
- Department of Dental Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Punnet Puri
- Department of Dental Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
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42
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Harmon M, Arrigan M, Toner M, O'Keeffe S. A radiological approach to benign and malignant lesions of the mandible. Clin Radiol 2015; 70:335-50. [DOI: 10.1016/j.crad.2014.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/08/2014] [Accepted: 10/22/2014] [Indexed: 12/22/2022]
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43
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44
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Beck-Broichsitter BE, Dau H, Moest T, Jochens A, Stockmann P, Wiltfang J, Becker ST. Immunohistological expression of human ß-defensin-1 and human ß-defensin-2 in exacerbation of acute and secondary chronic osteomyelitis of the mandible. J Oral Pathol Med 2014; 44:88-93. [DOI: 10.1111/jop.12202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - Heino Dau
- Department of Oral and Maxillofacial Surgery; Schleswig-Holstein University Hospital; Kiel Germany
| | - Tobias Moest
- Department of Oral and Maxillofacial Surgery; University Hospital Erlangen-Nürnberg; Erlangen Germany
| | - Arne Jochens
- Institute of Medical Informatics and Statistics; Schleswig-Holstein University Hospital; Kiel Germany
| | - Philipp Stockmann
- Department of Oral and Maxillofacial Surgery; University Hospital Erlangen-Nürnberg; Erlangen Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery; Schleswig-Holstein University Hospital; Kiel Germany
| | - Stephan T. Becker
- Department of Oral and Maxillofacial Surgery; Schleswig-Holstein University Hospital; Kiel Germany
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45
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Arai H, Inui K, Watanabe K, Watanuki K, Okudela K, Tsuboi M, Masuda M. Lung abscess combined with chronic osteomyelitis of the mandible successfully treated with video-assisted thoracoscopic surgery. CLINICAL RESPIRATORY JOURNAL 2014; 9:253-6. [PMID: 24506281 DOI: 10.1111/crj.12115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/16/2014] [Accepted: 01/25/2014] [Indexed: 11/27/2022]
Abstract
With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess.
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Affiliation(s)
- Hiromasa Arai
- Department of Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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46
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Mehra H, Gupta S, Gupta H, Sinha V, Singh J. Chronic suppurative osteomyelitis of mandible: a case report. Craniomaxillofac Trauma Reconstr 2014; 6:197-200. [PMID: 24436759 DOI: 10.1055/s-0033-1343781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/20/2012] [Indexed: 10/26/2022] Open
Abstract
Osteomyelitis is an inflammatory disease of the bone that usually begins as an infection of the medullary cavity, rapidly involves the haversian system, and quickly extends to the periosteum of the area. It develops in the jaws after a chronic odontogenic infection or for a variety of other reasons such as trauma, inadequate treatment of fracture, or irradiation to the mandible. When antimicrobial agents or drainage prove unsuccessful, acute osteomyelitis may become chronic. Conventional radiography, culture, bone biopsy, radioisotope bone scan, laser Doppler flowmetry, computed tomography, and magnetic resonance imaging are used for its diagnosis. We present a case of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which was successfully treated with surgical debridement and stabilization with a 10-hole reconstruction plate and bicortical screws using AO principles.
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Affiliation(s)
- Hemant Mehra
- Department of Oral and Maxillofacial Surgery, Babu Banarasi Das College of Dental Surgery, Lucknow, Uttar Pradesh, India
| | - Sumit Gupta
- Department of Oral and Maxillofacial Surgery, Babu Banarasi Das College of Dental Surgery, Lucknow, Uttar Pradesh, India
| | - Hemant Gupta
- Department of Oral and Maxillofacial Surgery, Babu Banarasi Das College of Dental Surgery, Lucknow, Uttar Pradesh, India
| | - V Sinha
- Department of Oral and Maxillofacial Surgery, Babu Banarasi Das College of Dental Surgery, Lucknow, Uttar Pradesh, India
| | - Jasmeet Singh
- Department of Oral and Maxillofacial Surgery, Babu Banarasi Das College of Dental Surgery, Lucknow, Uttar Pradesh, India
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47
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Yang JM, Ji YS, Yoon KC. A Case of Chronic Osteomyelitis of the Orbit. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.6.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jee Myung Yang
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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48
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Rapidly progressing osteomyelitis of the mandible. Case Rep Dent 2013; 2013:249615. [PMID: 24349802 PMCID: PMC3855945 DOI: 10.1155/2013/249615] [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: 08/16/2013] [Accepted: 10/02/2013] [Indexed: 12/22/2022] Open
Abstract
Acute osteomyelitis exists as a refractory disease even now, which usually exhibits systemic symptoms such as fever or malaise and local redness or swelling. The present paper describes a case of acute osteomyelitis of the mandible that was rapidly progressing without typical symptoms. The patient had liver cirrhosis, which should be one of the systemic factors that affect immune surveillance and metabolism. Actinomycotic druses and filaments were detected from the sequestrum. These were considered to play a role in the rapid progression of osteomyelitis without typical symptoms. There has been no evidence of local recurrence 24 months after surgery.
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Kumar GR, Syed BA, Prasad N, Praveen S. Chronic suppurative osteomyelitis of subcondylar region: a case report. Int J Clin Pediatr Dent 2013; 6:119-23. [PMID: 25206205 PMCID: PMC4086596 DOI: 10.5005/jp-journals-10005-1202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/25/2013] [Indexed: 11/23/2022] Open
Abstract
Chronic suppurative osteomyelitis (CSO) of the maxillofacial region is primarily caused by infections of odontogenic microorganisms. It may also arise as a complication of dental extractions, maxillofacial trauma, inadequate treatment of a fracture and irradiation to the mandible. This condition is characterized by areas of devitalized bone (sequestra) which serves as a nidus for recurrent episodes of infection. This case report describes a case of CSO in an untreated right subcondylar fracture of the mandible which was successfully treated with a combination of antibiotic therapy and surgical debridement in an 8-year-old boy. How to cite this article: Kumar GR, Syed BA, Prasad N, Praveen SP. Chronic Suppurative Osteomyelitis of Subcondylar Region: A Case Report. Int J Clin Pediatr Dent 2013;6(2): 119-123.
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Affiliation(s)
- G Ravi Kumar
- Assistant Professor, Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Hyderabad Andhra Pradesh, India, e-mail:
| | - Basheer Ahmed Syed
- Associate Professor, Department of Prosthodontics and Crown and Bridge Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
| | - N Prasad
- Assistant Professor, Department of Oral and Maxillofacial Surgery Government Dental College and Hospital, Hyderabad, Andhra Pradesh, India
| | - Sp Praveen
- Associate Professor, Department of Oral and Maxillofacial Surgery Government Dental College and Hospital, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
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50
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Chen L, Li T, Jing W, Tang W, Tian W, Li C, Liu L. Risk factors of recurrence and life-threatening complications for patients hospitalized with chronic suppurative osteomyelitis of the jaw. BMC Infect Dis 2013; 13:313. [PMID: 23844897 PMCID: PMC3711889 DOI: 10.1186/1471-2334-13-313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/08/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinically, recurrence and life-threatening complications are challenging problems for chronic suppurative osteomyelitis of the jaw (CSOJ), but there is no quantitative analysis or report about the causes of or risk factors for the two problems to date. Doctors identify the causes or risk factors only through clinical experience. We performed a retrospective study of 322 patients with CSOJ to quantificationally analysed the risk factors for the abovementioned two problems by logistic regression analysis. METHODS A retrospective study of 322 patients hospitalized with CSOJ was performed. The socio-demographic and clinical characteristics were recorded. The risk factors for the above two problems were analyzed by logistic regression analysis. Frequency and percentage were used to indicate descriptive research factors. A univariate logistic regression analysis was performed to calculate the odds ratio (OR) and to identify independent risk factors. The independent risk factors were further identified by multivariate logistic regression analysis. RESULTS An age from 6-12 years or > 65 years, pre-admission antibiotic administration, a lesion at the mandibular ramus, concurrent maxillofacial space infection (MSI), and conservation of pathogenic teeth were found to be risk factors for recurrence. An age > 65 years, admission temperature > 39 degree Celsius, admission white blood cell (WBC) count >15×109/L, pre-admission antibiotic administration, concurrent MSI, pre-existing diabetes, and respiratory difficulty were found to be risk factors for life-threatening complications. CONCLUSIONS The results indicate that doctors should remain mindful of the risk factors listed above, and the management of CSOJ should be increasingly aggressive when the above risk factors are present, especially when the lesion is located at the mandibular ramus. In addition, pathogenic teeth must be extracted, and antibiotics should be administered properly. TRIAL REGISTRATION Clinicaltrials.gov (NCT01670422).
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Affiliation(s)
- Lin Chen
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P.R. China
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610044, P.R. China
| | - Tangxin Li
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, P.R.China
| | - Wei Jing
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610044, P.R. China
| | - Wei Tang
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P.R. China
| | - Weidong Tian
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P.R. China
| | - Cai Li
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610044, P.R. China
| | - Lei Liu
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P.R. China
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