Multiple myeloma and pulmonary aspergillosis: dental treatment prior to chemotherapy and management of post extraction complications.

This case study discusses the dental management of a patient with a history of multiple myeloma and pulmonary aspergillosis, whom was referred to a hospital-based dental service for urgent dental review. The patient had received a dental assessment in primary care prior to commencement of chemotherapy and had four teeth extracted without complications. However, following the commencement of chemotherapy, he presented with a significant infection associated with two of his wisdom teeth resulting in extraction. Despite atraumatic extraction, the upper right wisdom tooth socket developed an oroantral fistula. A multidisciplinary team approach was required to enable effective patient management in this complex patient regarding myeloma, aspergillosis and the medications used including bisphosphonates and chemotherapy. It highlights the higher risk of oral complications that can arise in myelosuppressed patients and emphasises the need to identify potential sources of dental infection prior to the commencement of chemotherapy.

A case of coinfection in a chronic maxillary sinusitis of odontogenic origin: identification of Dialister pneumosintes.

INTRODUCTION: In this report, we discuss the case of a 39-year-old woman presenting with a case of chronic maxillary sinusitis. METHODS: Dialister pneumosintes, Staphylococcus epidermidis, and Peptostreptococcus spp. were isolated from endosinusal samples obtained during surgery. The patient showed extensive periodontopathy and had undergone prior endodontic treatment for endodontic infection of teeth #13, #14, and #15, which failed and presumably acted as a bridge for the sinusal infection. After nasosinusal surgery, consisting of opening and toilet of the maxillary sinus, combined with extraction of the 3 previously mentioned teeth and antibiotic treatment, the patient showed complete healing. RESULTS: S. epidermidis and Peptostreptococcus spp. were identified with a traditional biochemical test and confirmed by pyrosequencing. Conversely, D. pneumosintes could not be identified with the conventional method, but it was identified using DNA pyrosequencing. In addition, to better understand the role and the virulence of this bacterium in odontogenic sinusitis, we have evaluated the ability of D. pneumosintes to produce biofilms onto inert surfaces. D. pneumosintes is a known endodontic and periodontal pathogen found in necrotic pulp, subgingival plaque, and deep periodontal pockets. CONCLUSIONS: To our knowledge, the pathogenic role of D. pneumosintes in odontogenic sinusitis has never been evidenced. Thus, its detection in endosinusal specimens may provide a significant insight into the pathogenesis of this relevant medical condition.

Intercurrent infectious diseases in post-stem cell transplant patients: paranasal sinusitis.

Improvements in treatments available for oncohematologic diseases have made it possible to treat patients at more advanced stages of the disease and thus at greater risk of fungal, bacterial, and viral infections; these may be extensive and have aggressive evolution. In particular, chemotherapy at high doses and allogenic bone marrow transplant expose patients to an increased risk of infection, especially because of the period of aplasia and the condition of immune depression subsequent to the procedure. We presented a case of a 15-year-old adolescent girl diagnosed with combined relapse of acute lymphoblastic leukemia 2 years after completion of first-line chemotherapy that, at 120 days after transplant, erosive lesions of the palatal mucosa at the left hemipalate in the area adjacent to tooth 2.7 were detected, of approximately 2 mm in size. These gave rise to an orosinus communication. Various therapeutic possibilities are examined. These cases are not frequent. Diseases and their related complications require an in-depth knowledge, on the part of the stomatologist, to recognize the early signs of involvement of the oral cavity and, on the part of the oral surgeon, to decide the most appropriate therapeutic strategy.

Oroantral fistula and genian mucosal flap: a review of 25 cases.

UNLABELLED: The oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. The condition mostly follows dental extraction. AIM: To present the experience of 25 cases. MATERIAL AND METHODS: Retrospective cases between 1996-2000. The ORL examination included nasal or sinusal endoscopy, a CT scan and histopathological analysis. RESULTS: Twenty-five cases were found: ten 2nd molar cases, eight 1st molar cases, six 2nd premolar cases, and one canine case. All patients underwent a Caldwell-Luc operation plus excision of the epithelium lining the fistula, that was then completely covered by a flap of mucosa rotated from the genian region. DISCUSSION: In cases of major fistulae a bone autograft taken from the anterior sinus wall was used. Bacterial cultures (n=19) revealed streptococus pneumoniae (13), haemophillus influenza (6), Moraxella catharralis (2) and staphylococus aureus (2). Aspergillus niger was found in one case presenting as a "fungic ball". CONCLUSIONS: The only case of surgical failure, after 30 days postoperatively, was reoperated, using a bone graft. After a 6-month follow up all of the patients progressed satisfactorily, including the reoperated patient.

Fístula oroantral e retalho mucoso geniano: revisão de 25 casos / Oroantral fistula and genian mucosal flap: a review of 25 cases

A fístula oroantral é a comunicação patológica entre cavidade oral e seio maxilar, quase sempre decorrentes de traumatismos durante procedimentos dentários. OBJETIVO: Apresentar experiência de 25 casos. CASUÍSTICA E MÉTODOS: Realizado estudo retrospectivo de pacientes com FOA no período de 1996 a 2000. O diagnóstico incluiu exame otorrinolaringológico, endoscopia nasal ou da fístula, tomografia computadorizada das cavidades paranasais, pesquisa bacteriológica, fúngica e análise patológica. RESULTADOS: Encontrados 25 casos, sendo 10 de segundo molar, 8 de primeiro molar, 6 de segundo pré-molar e 1 de canino. Todos foram operados pela técnica de Caldwell-Luc, reavivamento das bordas da fístula, meatotomia média e rotação de retalho mucoso geniano. DISCUSSÃO: Nas fístulas de alto débito (n=14), colocou-se enxerto ósseo da própria parede anterior do seio. Todos, exceto um, tiveram resultado cirúrgico bom. A cultura bacteriológica (n=19) demonstrou estreptococos pneumoniae (13), haemophilus influenzae (6), moraxella catarrhalis (2), estafilococos aureus (2). Encontrado aspergilus niger em um caso que apresentava imagem radiológica de bola fúngica. CONCLUSÕES: Após 30 dias, os resultados foram bons em todos, exceto um dos casos. Este foi reoperado com colocação de enxerto ósseo, inicialmente não utilizado, tendo sucesso. Após 6 meses, todos os 23 pacientes localizados não apresentavam problemas.

The oroantral fistula is a pathological connection between the maxillary sinus and with the oral cavity. The condition mostly follows dental extraction. AIM: To present the experience of 25 cases. MATERIAL AND METHODS: Retrospective cases between 1996-2000. The ORL examination included nasal or sinusal endoscopy, a CT scan and histopathological analysis. RESULTS: Twenty-five cases were found: ten 2nd molar cases, eight 1st molar cases, six 2nd premolar cases, and one canine case. All patients underwent a Caldwell-Luc operation plus excision of the epithelium lining the fistula, that was then completely covered by a flap of mucosa rotated from the genian region. DISCUSSION: In cases of major fistulae a bone autograft taken from the anterior sinus wall was used. Bacterial cultures (n=19) revealed streptococus pneumoniae (13), haemophillus influenza (6), Moraxella catharralis (2) and staphylococus aureus (2). Aspergillus niger was found in one case presenting as a "fungic ball". CONCLUSIONS: The only case of surgical failure, after 30 days postoperatively, was reoperated, using a bone graft. After a 6-month follow up all of the patients progressed satisfactorily, including the reoperated patient.

Hard palate perforation due to mucormycosis: report of four cases.

INTRODUCTION: Mucormycosis is an opportunistic, fulminating fungal infection of the sino-nasal region. It tends to affect people with immune suppression. The hard palate is a rare site of the disease and few cases have been reported in the literature. This report discusses the nature of hard palate mucormycosis, with the aim of outlining possible explanations and reviewing associated characteristics. METHOD: This was a prospective analysis of four cases of hard palate mucormycosis. The patients were referred from the medical department, with uncontrolled diabetes mellitus. An aggressive treatment protocol was used, i.e. an intensive course of antifungal drugs and frequent debridement of dead tissue. RESULTS: A painful, dusky red swelling was noticed at the early stages of the hemi-palate lesion. It was eventually followed by deep ulceration and even big perforation. Orbit and intracranial extension was the preceding sign in all instances. The progression of the perforation was not controlled by a full course of treatment. There were two deaths during the treatment course. IN CONCLUSION: Mucormycosis of the hard palate is an ominous sign. Although rare, the lesion is progressive in nature and barely controlled by treatment. Clinicians should maintain a high degree of clinical suspicion in the management of patients with palatal ulcer and debilitating illness.

Mucormycosis presenting as palatal perforation.

Mucormycosis is an opportunistic fungal infection that is caused by normally saprobic organism of the class Zygomycetes. The main form of mucormycosis are pulmonary and rhinocerebral. Rhinocerebral mycormycosis typically starts in the maxillary antrum, particularly in poorly controlled diabetics. Invasion of surrounding tissue can cause necrotizing ulceration of palate with a blackish slough and exposure of bone. A case of mucormycosis presenting as palatal performation is discussed in this article.

[Comparative microbiological, macro- and microscopic and x-ray findings in iatrogenic perforation of the maxillary sinus depending on the time of its lancing]. / Vergleichende mikrobiologische, makro- und mikroskopische sowie röntgenologische Befunde bei iatrogener Kieferhöhlenperforation in Abhängigkeit von der Eröffnungsdauer.

To determine whether the inflammation afflicting the sinus mucosa shortly after oroantral communication is due to an injury or an infection, microbiological studies of two biopsy preparations each were performed simultaneously in 20 patients with the diagnosis: radix in antro. As a rule, notwithstanding the time of oroantral communication aerobe micro-organisms corresponding to the local conditions of oral and nasal flora. Primary asepsis of the sinus mucosa being assumed, an infection of the sinus maxillary has to be taken into account only one hour after the dislocation of a root of the tooth into the sinus maxillary. After six hours the infection will be followed by an inflammatory reaction.

A study of operative treatment and bacteriological examination of persistent oro-antral fistulas.

A retrospective study of 35 patients with oro-antral fistulas of more than 2 weeks duration is presented. Treatment results by using the Rehrmann plastic procedure, as well as complications and sequelae are described. The results of bacteriological examination in 15 patients with maxillary sinusitis in association with oro-antral fistulas are presented. The bacteriological findings suggest that broad spectrum antibiotics in certain conditions should be administered in cases of persisting oro-antral fistulas associated with maxillary sinusitis. The results of the present study show that the Rehrmann-operation proves satisfactory even in treatment-resistent cases.