Osteomyelitis of the mandible in a patient with osteopetrosis. Case report and review of the literature.

Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density and reduction of marrow spaces that result from a defect in the function of osteoclasts and, consequently, a decrease in bone turnover. This disease is generally divided into three types: severe infantile malignant autosomal recessive, intermediate mild autosomal recessive, and benign autosomal dominant. The prognosis of the first two types is very poor and is characterized by an early onset, usually within the first decade of life, and early death. The benign-type is characterized by a later onset and a longer life span. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. The osteomyelitis is generally caused by tooth extraction or pulpal necrosis. The leading cause of the increased rate of infection is thought to be a lack of adequate bone vasculature. Treatment of osteomyelitis secondary to osteopetrosis is controversial. Treatment regimens include high-dose systemic antibiotics coupled with thorough debridement of necrotic bone and primary closure of soft tissues, if possible. Hyperbaric oxygen has been used for the treatment of chronic osteomyelitis.

Time used for orthodontic surgical treatment of dentofacial deformities in white patients.

PURPOSE: The aim of the present study was to assess the duration of each treatment phase that a patient with dentofacial disorders and eligible for orthodontic surgery undergoes and to identify those factors that determine the time. We have also included a description of the demographic and skeletal characteristics of the patients treated at our center, the surgery type, and movements performed. PATIENTS AND METHODS: A sample of 148 patients undergoing orthognathic surgery from 2004 to 2007 at Princesa University Hospital, Madrid, was studied. The demographic data of each patient, their facial pattern, skeletal disorders, and surgical movements performed were recorded, as was the duration of orthodontic treatment, both pre- and postoperatively, length of surgery, and length of hospital stay. RESULTS: The length of preoperative orthodontic treatment was 24 months and that of postoperative treatment was 12 months. The average operative time was 4 hours for those interventions in which both dental arches were involved, and the average length of hospital stay was 3 days. No relevant differences were found for the length of orthodontic treatment according to gender, age, or type of skeletal disorder. Differences were observed in the length of hospital stay between those patients who underwent segmentation of the maxilla and those who did not. CONCLUSIONS: The length of the different phases into which an orthodontic surgical treatment is divided can differ within some given limits. However, it does not depend on either the patients' demographic skeletal characteristics or the surgical movements performed.