[Osteomyelitis of the jaws - review of the literature and a case report].

Osteomyelitis (OM), is a rare disease in developed countries. It is defined as a progressive inflammation of the bone and the bone marrow, and characterized by formation of necrotic bone. This disease is more common in the lower jaw, which resembles the structure of a long bone. However, there are histologic and microbiologic characteristics that constitute important factors in the etiology and pathogenesis of the disease and therefore it is not possible to make an analogy from OM of long bones to OM of the jaws. The diagnosis of OM is based on a detailed anamnesis, clinical findings, laboratory tests and imaging. The treatment of OM consists of surgical treatment, which is considered the mainstay of the treatment, and antibiotic treatment, parenteral and oral which is considered as complementary therapy. There are several surgical procedures, according to the extent of the lesion, which include: drainage, curettage, sequestrectomy, saucerization, decortications and resection. A case of osteomyelitis of the lower jaw after dental treatment is presented. The patient underwent segmental resection and reconstruction.

[The improvement of complex treatment of odontogenous periostitis in elderly patients].

The paper presents the results of clinical examination of 114 patients aged 60-88 years with acute odontogenous periostitis receiving treatment in in-patient maxillofacial surgery unit. The dynamic of clinical symptoms is used to carry out the comparative effectiveness study of several peroral antibiotics in elderly patients.

Oral bisphosphonate therapy and osteonecrosis of the jaw: what to tell the concerned patient.

Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is encountered predominantly in cancer populations being treated with high-dose intravenous bisphosphonates for skeletal complications such as bone metastases and secondary fracture risk. A minority of BONJ lesions have been observed in patients receiving oral bisphosphonates for management of osteoporosis or osteopenia. In this paper, the current knowledge pertaining to the incidence, definition, and signs and symptoms of BONJ is presented, followed by a discussion of the incidence and consequences of osteoporotic skeletal fracture and the use of oral bisphosphonates to mitigate fracture. The risk of BONJ appears to be very small in patients taking oral bisphosphonates. In addition, the consequences of osteoporotic fracture likely have significantly greater mortality and morbidity than BONJ. Within this context, management concepts and guidelines are presented to help the dental clinician allay concerns about BONJ expressed by patients receiving oral bisphosphonate therapy.

Hyperbaric oxygen in addition to antibiotic therapy is effective for bisphosphonate-induced osteonecrosis of the jaw in a patient with multiple myeloma.

A 60-year-old man with multiple myeloma (MM) (IgG-kappa, stage IIIA) had been treated with minodronate at 6 mg orally as a phase 1 clinical trial for myeloma bone disease for 13 months (total dose, 4032 mg). Then he received incadronate at 10mg intravenously every 1 to 4 weeks (total dose, 350 mg). In July 2005, he complained of mild right mandibular pain, and bone scintigram showed a hot spot at the right side of the mandible. Panoramic radiograph showed osteonecrosis of the jaw (ONJ) and axial and 3-dimensional computed tomography confirmed ONJ. Oral examination showed massive gingival swelling of the right side of the mandible without exposed necrotic bone. He was given clarithromycin in addition to levofloxacin, followed by hyperbaric oxygen (HBO) therapy, which resulted in the complete disappearance of the pain. This is a first reported case of ONJ induced by incadronate. The present case suggests that early detection of ONJ by regular dental check-ups is important in the management of patients with MM who have received bisphosphonate therapy, and HBO in combination with antibiotic therapy is effective in the early stage of ONJ.

Osteomielitis en los maxilares, reporte de 25 casos / Osteomyelitis in the jaws, report of 25 cases

En el presente estudio se analizan 25 pacientes vistos en la Unidad Estomatológica del Hospital Universitario San Vicente de Paul de Medellín, Colombia, y cuyas edades oscilaron entre los 2 y los 73 años, con diagnóstico clínico de osteomielitis, el cual fue corroborado tanto por los estudios radiográficos como por los histopatológicos. De los casos analizados, el 80 por ciento fue observado a nivel de la mandíbula y el 20 por ciento en el maxilar superior. Un 72 por ciento de los pacientes presentó en el momento de la consulta, fístulas activas, de las cuales el 56 por ciento eran intraorales y el 16 por ciento extraorales

[Osteoradionecrosis. A review of the literature]. / L'ostéoradionécrose. Une revue de la littérature.

Osteoradionecrosis is a severe complication of radiotherapy characterized by the following sequence: radiation, trauma, bone exposure. The radiation reduces the vascularization potential of the tissues which leads to a hypoxic state that jeopardizes cellular activity and collagen formation. The diagnosis of osteoradionecrosis relies on the clinical examination of chronically exposed bone. Although this type of lesion is not limited to the jaws, the ratio between mandible and maxilla is 24:1. The severity of the lesion is a function of the radiation dosage. The main etiological factors of osteoradionecrosis are related to dental and periodontal pathology as well as to tooth extraction performed after, during or shortly before radiotherapy. Edentulous patients are less exposed to osteoradionecrosis than dentulous patients. Local treatment and antibiotic therapy are initially performed in mild cases. Surgical measures with hemiresection or block resection are indicated depending on the severity of the lesion. Some authors regard hyperbaric oxygen treatment as an efficient therapeutic and preventive technique. Prevention is of major concern. It requires a careful evaluation of soft and hard tissues of the oral cavity as well as the organization of an intensive prophylaxis program. Patient compliance is a prerequisite. This article is a literature review on osteoradionecrosis with its symptoms, incidence, pathogenesis, treatment and prevention.

Jawbone cavities and trigeminal and atypical facial neuralgias.

The possible role of dental and oral disease in the etiology of idiopathic trigeminal and atypical facial neuralgias has been examined. Among thirty-eight patients with idiopathic trigeminal neuralgia and twenty-three patients with atypical facial neuralgia, there was in nearly all instances a close relationship between pain experienced and the existence of cavities in alveolar bone and jawbone of the patients. The cavities were at the sites of previous tooth extractions and, although at times more than 1 cm. in a given diameter, were usually not detectable by x-rays. A new method for their detection and localization was developed empirically, based on the observation that peripheral infiltration of local anesthetic into or very close to the bone cavity rapidly abolished trigger and pain perception by patients during persistence of the anesthetic action. Histopathologic examination of bone removed from cavities by curettage revealed, in both idiopathic trigeminal and atypical facial neuralgias, a similar pattern characterized by a highly vascular abnormal healing response of bone. Some lesions presented a mild chronic inflammatory (lymphocytic) infiltration. Preliminary microbiologic studies of material from the walls of the cavities showed the existence within them of a complex, mixed polymicrobial aerobic and anaerobic flora. Treatment consisted of vigorous curettage of the bone cavities, repeated if necessary, plus administration of antibiotics to induce healing and filling-in of the cavities by new bone. Responses of patients to the above treatment consisted of marked to complete pain remissions, the longest of which has been for 9 years. Complete healing leads to complete and persistent pain remissions. It was concluded that in both idiopathic trigeminal and atypical facial neuralgias, dental and oral pathoses may be major etiologic factors.