Odontogenic Osteomyelitis in Healthy Individualscomplications in the Sars-Cov-2 Pandemic

Introduction: Osteomyelitis is an infection of the bone that usually affects immunocompromised individuals with multiple comorbidities. Maxilla and the mandible are at risk because of close contact with primarily contaminated spaces of the oral cavity and maxillary sinus that can harbor subclinical infection and a thin mucosal layer that adheres to the periosteum. Recently, odontogenic osteomyelitis has become rare due to better oral hygiene, stomatological care, and the widespread use of antibiotics. During the pandemic of the SARS-CoV-2 virus, the availability of medical care was limited, and the number of complicated infections rose. Case report: We present two cases of odontogenic osteomyelitis of the mandible in healthy individuals that were complicated with relapses and SARS CoV-2 coinfection. The first patient was a 30-year-old otherwise healthy female who developed localized osteomyelitis after extraction of the tooth 38. She was asymptomatic but tested positive for SARS-CoV-2. The second patient was a COVID-19-positive 29-year-old male with no previous illnesses, whose odontogenic abscess and neck edema compromised the airway, requiring urgent tracheotomy. After two weeks he developed a relapse of the infection and osteomyelitis of mandibular ramus with the formation of sequestrum. Coinfection with SARS CoV-2 virus could aggravate osteomyelitis by causing immune dysfunction and depletion of CD-4 and CD-8 lymphocytes. The osteomyelitic site is hypoperfused because of tissue edema and the inability of intraosseal spaces to expand. Endothelial le-sions and increased coagulation in COVID infection could contribute to hypoperfusion and the spread of the infection. Currently, it is impossible to claim that SARS CoV-2 infection aggravated the clinical status of our patients, but further studies are needed about the impact of SARS CoV-2 infection on other organs and illnesses, especially in mild and asymptomatic cases.

Grisel's Syndrome and Covid Infection in Children: Report of Two Cases

Introduction: Grisel syndrome is a rare condition of rotator subluxation of the atlantoaxial joint that is not associated with trauma or bone lesion. It is characterized by acute and painful torticollis with fever, which is a consequence of complicated pharyngitis and tonsillitis. Material(s) and Method(s): We present two girls, aged 5 and 6 years, who developed atlantoaxial subluxation and torticollis during or after infection with COVID. As part of this, a pararetropharyngeal abscess developed. Based on clinical signs, radiological findings, and the course of the disease, Grisel's syndrome was confirmed. One patient had an asymptomatic COVID infection, before the development of Grisel's syndrome, and the other patient had an active COVID infection, during which Grisel's syndrome developed. Result(s): Both patients were treated multidisciplinary: conservatively with antibiotics and surgically, and then physical therapy was introduced along with the Philadelphia orthosis. Both were in constant clinical improvement and did not develop further complications. According to the literature, the Fielding-Hawkins classification describes 4 degrees of this subluxation, and our patients had type 3 at the time of diagnosis. Conclusion(s): Grisel's syndrome is a rare condition and should be suspected in children with painful torticollis after infections or head and neck surgery. The importance of this syndrome for maxillofacial surgeons is in early differential diagnosis, to avoid early and late consequences of undiagnosed pararetropharyngeal abscess and atlantoaxial subluxation and compression of vital structures. Grisel's syndrome needs to be treated multidisciplinary and immediately.

Dermal Fillers and Covid - Delayed Inflammatory Reaction

Introduction: Dermal hyaluronic fillers are considered one of the most common minimally invasive procedures in aesthetic surgery. In the last three years, the human population has been significantly affected by the viral disease COVID-19, from which 559 million people have fallen ill and 6.36 million have died worldwide. A new, rare but significant side effect of the COVID-19 disease or a consequence of vaccination against COVID is a delayed inflammatory reaction in the area where dermal fillers were applied. Material(s) and Method(s): We present the case of two patients who developed a delayed inflammatory reaction in the area of the applied filler two and four months after the application of hyaluronic fillers for lip augmentation, and after recovering from COVID and receiving the vaccine against COVID. In both patients, the reaction was manifested by localized edema. Localized infection and the possibility of an allergic reaction to the preparation are excluded. Result(s): After the oral therapy was applied (antihistamines and pulse therapy with corticosteroids) within 24 hours, there was an improvement in the findings and a local regression of the inflammatory reaction. Conclusion(s): A literature review revealed several described cases of delayed inflammatory reaction after a COVID-19 infection or vaccination against COVID, and this side effect is still not often seen in clinical practice. The reaction between the hyaluronic acid filler and the SarsCoV-2 virus is believed to be immune-mediated. Since patients often initially contact the doctor who applied the filler, it is necessary to take into account information about past infection or vaccination in the anamnestic before administering the filler, and to take the delayed inflammatory reaction into account in the differential diagnosis. It is important to recognize this complication in time, to prevent more severe complications in time.