COVID-19-associated Parotid Gland Abscess.

BACKGROUND: Human infection with the SARS-CoV-2 virus has caused a pandemic characterized by a plethora of diseases, of which those affecting the internal organs and nervous system can have severe, life-threatening consequences. Among the manifestations of the disease at the viral entry site, diseases in oral mucosa adnexa are rarely reported. This case report describes a COVID-19-associated aggravating parotid gland disease. CASE REPORT: The 47-year-old, SARS-CoV-2-positive male patient, already hospitalized and now in need of ventilation, had been referred for intensive care treatment due to increasing respiratory problems. A unilateral swelling of the cheek was noticed, the cause of which was initially a parotid gland infection. Examination ruled out mechanical causes of the parotid gland. During further treatment, the patient developed a parotid abscess, which was drained extra orally. CONCLUSION: The oral cavity is primarily considered as a reservoir of the pathogen. There is an increasing number of reports detailing inflammation of the major salivary glands associated with SARS-CoV-2 virus. Knowledge of this association facilitates therapeutic decisions.

Retrospective analysis of bacterial colonization of necrotic bone and antibiotic resistance in 98 patients with medication-related osteonecrosis of the jaw (MRONJ).

OBJECTIVES: The aim of our study was to describe microbial flora associated with MRONJ and characterize the susceptibility of pathogens to help guide an effective empiric antibiotic treatment in these patients. MATERIALS AND METHODS: A retrospective, single-center analysis was performed, using 116 bone samples from 98 patients. The bone samples were homogenized and subjected to routine culture methods. Growing bacteria were differentiated to the species level using whole-cell mass spectrometry and subjected to susceptibility testing. RESULTS: A highly diverse microbial flora was detected in necrotic bone, with a simultaneous presence of two or more bacterial species in 79% of all patients. In at least 65% of samples, gram-negative isolates were detected. Therefore, bacterial species resistant against ß-lactamase inhibitors were present in at least 70% of all patients. CONCLUSIONS: The empiric choice of antibiotics in MRONJ patients should consider the high rate of gram-negative bacteria and resistance against ß-lactam antibiotics. CLINICAL RELEVANCE: According to recent guidelines and recommendations, systemic antibiotic treatment is a key component in the treatment of all stage 2 and 3 MRONJ patients. We recommend using fluoroquinolones for empiric treatment and emphasize the use of bacterial cultivation and susceptibility testing to enable an effective antibiotic treatment.

Postoperative bleeding risk for oral surgery under continued rivaroxaban anticoagulant therapy.

OBJECTIVES: The purpose of this study was to assess the risk of postoperative bleeding complications after oral procedures performed under continued mono or dual anticoagulation therapy with rivaroxaban (and aspirin). METHODS: This retrospective single-center observational study included 52 oral procedures performed under continued oral anticoagulant therapy with rivaroxaban (20 mg/day). Among them, two procedures were performed under continued dual therapy with aspirin (100 mg/day) added to the regimen. Postoperative bleeding events were compared with 285 oral procedures in patients without any anticoagulation/antiplatelet therapy. RESULTS: Postoperative bleeding complications after oral surgery occurred significantly more often in patients under continued rivaroxaban therapy (11.5 %) than in the control cases without anticoagulation/antiplatelet medication (0.7 %). All of the bleeding events were manageable: Two of them were treated with local compression, three by applying new fibrin glue with (one case) or without (two cases) secondary sutures, one occurred during a weekend and was therefore treated under inpatient conditions with suture replacement. All postoperative bleeding episodes occurred during the first postoperative week. CONCLUSIONS: According to our data, continued anticoagulation therapy with rivaroxaban significantly increases postoperative bleeding risk for oral surgical procedures, although the bleeding events were manageable. CLINICAL RELEVANCE: Oral surgeons, cardiologists, general physicians, and patients should be aware of the increased bleeding risk after oral surgical procedures. Close observation up to 1 week postoperatively is advisable to prevent excessive bleeding.