Chronic osteomyelitis associated with mandibular fracture in a pediatric patient - case report

Authors

DOI:

https://doi.org/10.33448/rsd-v11i3.27004

Keywords:

Osteomyelitis; Anti-Bacterial agents; Surgery, oral; Mandibule.

Abstract

Osteomyelitis is an inflammation characterized by involving the medullary spaces of the bones. In the jaw, it can occur as a result of local infections, trauma, surgical procedures and caries, affecting the mandible more than the maxilla. Patients usually present with painful symptoms, edema, trismus, fever and bone sequestration. The aim of this paper is to report a case of chronic osteomyelitis associated with mandibular fracture in a pediatric patient, going through the stages of diagnosis, drug treatment and surgery. A five-year-old female patient was referred to the hospital unit with a history of inflammation in the left mandibular region and a fall from her own height. On physical examination, he presented edema in the left hemiface and fistula in the left mandibular angle region with active drainage of a purulent collection. On intraoral examination, he presented dental elements with extensive destruction by caries. The tomographic examination showed a process of osteolysis, spinal cord destruction and mandibular fracture, which, associated with the patient's history and clinical characteristics, led to the diagnostic hypothesis of mandibular osteomyelitis associated with pathological fracture. Initially, antimicrobial therapy was instituted aiming at a less aggressive and more conservative surgical intervention, and we opted for conservative treatment of the fracture in the mandible angle region. The surgical procedure consisted of debridement of necrotic tissue and extractions. It is known that osteomyelitis in pediatric patients is relatively uncommon and that it can generate conditions that are difficult to resolve, especially when not treated quickly and early. Diagnostic delays can evolve and reach prime anatomical areas such as the cervical region and mediastinum, leading to the risk of death.

References

Aranha, A. C. (2021). Lasers na prática clínica diária (1st ed.). Santos Publicações.

Araujo, J., Lima Fonseca, K., Queiroz Danda, T., de Sousa Teixeira, A., & Azenha, M. (2018). Suppurative Chronic Osteomyelitis: Case Report. International Journal of Biomedical Investigation, 1(2), 1–4. https://doi.org/10.31531/2581-4745.1000112.

Baltieri, B., Pereira Filho, V., & Lopes, F. (2014). Osteomielite em mandíbula de criança. Revista de Odontologia da UNESP, 43(Especial), 1–1.

Berglund, C., Ekströmer, K., & Abtahi, J. (2015). Primary chronic osteomyelitis of the jaws in children: An update on pathophysiology, radiological findings, treatment strategies, and prospective analysis of two cases. Case Reports in Dentistry, 2015, 1–12. https://doi.org/10.1155/2015/152717.

Cordeiro, I. S. H., Mendonça, J. C. G. de, Pelissaro, G. S., Antunes, D. M., Silva, J. C. L. da, Aguillera, M. de O., Figueiredo, F. T., & Gaetti-Jardim, E. C. (2022). Osteomielite mandibular após extração dentária traumática: Relato de caso. Research, Society and Development, 11(1), 1–9. https://doi.org/http://dx.doi.org/10.33448/rsd-v11i1.24815.

Fullmer, J. M., Scarfe, W. C., Kushner, G. M., Alpert, B., & Farman, A. G. (2007). Cone beam computed tomographic findings in refractory chronic suppurative osteomyelitis of the mandible. British Journal of Oral and Maxillofacial Surgery, 45(5), 364–371. https://doi.org/10.1016/j.bjoms.2006.10.009.

Gaetti-Jardim Júnior, E., Fardin, A. C., Gaetti-Jardim, E. C., de Castro, A. L., Schweitzer, C. M., & Avila-Campos, M. J. (2010). Microbiota associated with chronic osteomyelitis of the jaws. Brazilian Journal of Microbiology, 41(4), 1056–1064.

Gaetti-Jardim Júnior, E., Gaetti-Jardim, E. C., Faverani, L. P., Landucci, K. C., & Landucci, L. F. (2008). Osteomielite Crônica dos Maxilares: Aspectos Clínicos, Terapêuticos e Microbiológicos. Salusvita, 27(1), 125–139.

Garcez, A. S., Nunez, S. C., & Ribeiro, M. S. (2021). Aplicações clínicas do laser na odontologia (1st ed.). Manole.

Georgaki, M., Delli, K., Paschalidi, P., Gkizani, S., Tsiklakis, K., & Nikitakis, N. G. (2022). Chronic Osteomyelitis With Proliferative Periostitis of the Mandible in a Child. Pediatric Infectious Disease Journal, 41(1), 10–15. https://doi.org/10.1097/inf.0000000000003368.

Goda, A., Maruyama, F., Michi, Y., Nakagawa, I., & Harada, K. (2014). Analysis of the factors affecting the formation of the microbiome associated with chronic osteomyelitis of the jaw. Clinical Microbiology and Infection, 20(5), 0309–0317.

Gonçalves, K. K. N., Mendonça, T. L. R., Nascimento, V. H. S. do, Costa-Neto, O. F. da, Diniz, D. A., Souza-Júnior, F. A. de, Santos, M. S. dos, Silva, C. C. G., Barros, A. V. M. de, Lago, C. A. P. do, & Vasconcelos, B. C. do E. (2021). Manejo de osteomielite mandibular em paciente pediátrico: relato de caso. Research, Society and Development, 10(2), 1–9. https://doi.org/http://dx.doi.org/10.33448/rsd-v10i2.12853.

González-Navarro, B., Arranz-Obispo, C., Albuquerque, R., Jané-Salas, E., & López-López, J. (2017). Osteomyelitis of the jaw (with pathological fracture) following extraction of an impacted wisdom tooth. A case report. Journal of Stomatology, Oral and Maxillofacial Surgery, 118(5), 306–309. https://doi.org/10.1016/j.jormas.2017.05.003.

Hupp, J. R., Ellis, E., & Tucker, M. R. (2010). Cirurgia Oral e Maxilofacial Contemporânea. Elsevier, 1563.

Ilahi, N. T., Awal, D., Mills, C., & Ayliffe, P. (2017). Mandibular osteomyelitis after group A streptococcal septicaemia in a child. British Journal of Oral and Maxillofacial Surgery, 55(3), 341–342. https://doi.org/10.1016/j.bjoms.2016.08.020.

Lentrodt, S., Lentrodt, J., Kübler, N., & Mödder, U. (2007). Hyperbaric Oxygen for Adjuvant Therapy for Chronically Recurrent Mandibular Osteomyelitis in Childhood and Adolescence. Journal of Oral and Maxillofacial Surgery, 65(2), 186–191. https://doi.org/10.1016/j.joms.2005.11.106.

Lima, A. L. L., Oliveira, P. R., Carvalho, V. C., Cimerman, S., Savio, E., Sosa, A., López, A., Rodriguez Taveras, C. J., Ferreira Starling, C. E., Kiffer, C., Dos Santos, E. L. B., Molinedo Pérez, L. E., Coura Filho, G. B., Del Sel, H., Pezzarossi Zelaya, H. E., Marinho, I., Lopes Rocha, J. L., Matheus Guimarães, J. A., Mello Sampaio, J. L., … Junior, W. R. (2014). Recommendations for the treatment of osteomyelitis. Brazilian Journal of Infectious Diseases, 18(5), 526–534. https://doi.org/10.1016/j.bjid.2013.12.005.

Lin, Y. J., & Lu, P. (2006). Retrospective Study of Pediatric Facial Cellulitis of Odontogenic Origin. Pediatr Infect Dis J, 25(4), 339–342. https://doi.org/10.1097/01.inf.0000216202.59529.3d.

Masocatto, D. C., Oliveira, M. M., & Mendonça, J. C. G. de. (2017). Osteomielite crônica mandibular: relato de caso. Archives of Health Investigation, 6(2), 48–52. https://doi.org/10.21270/archi.v6i2.1783.

Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. D. (2008). Princípios de cirurgia bucomaxilofacial de Peterson. São Paulo: Editora Santos, 1, 1461.

Montonen, M., Iizuka, T., Hallikainen, D., & Lindqvist, C. (1993). Decortication in the treatment of diffuse sclerosing osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol, 75, 5–11.

Moratin, J., Freudlsperger, C., Metzger, K., Braß, C., Berger, M., Engel, M., Hoffmann, J., & Ristow, O. (2021). Development of osteomyelitis following dental abscesses—influence of therapy and comorbidities. Clinical Oral Investigations, 25(3), 1395–1401. https://doi.org/10.1007/s00784-020-03447-6.

Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2016). Patologia Oral e Maxilo Facial (4th ed.). Elsevier.

Oliva, A. H. de, Lemos, C. A. A., Santiago-Júnior, J. F., Masocatto, D. C., Deus, C. B. D. de, Hassumi, J. S., Jardim, E. C. G., & Pellizzer, E. P. (2021). Surgical drainage vs conservative treatment of odontogenic cellulitis in pediatric patients: A systematic review. Research, Society and Development, 10(9). https://doi.org/10.33448/rsd-v10i9.18244.

Pereira, A., Shitsuka, D., Parreira, F., & Shitsuka, R. (2018). Método Qualitativo, Quantitativo ou Quali-Quanti. In Metodologia da Pesquisa Científica (1st ed.). UFSM.

Pimentel, T., Hadad, H., Jesus, L. K., Colombo, L. T., Alcantara, A. G., Souza, F. Á., & Gárcia-Júnior, I. R. (2021). Pathological fracture of the jaw due to osteomyelitis after a third molar extraction. Archives of Health Investigation, 10(4), 637–640. https://doi.org/10.21270/archi.v10i4.4942.

Prasad, K. C., Prasad, S. C., Mouli, N., & Agarwal, S. (2007). Osteomielite na cabeça e pescoço. Acta Otolaryngol., 127(2), 194–205.

Ribeiro, A. L. R., Mendes, F. R. de O., Melo, M. M. de, Carneiro Júnior, J. T., & Pontes, H. A. R. (2009). Tratamento da osteomielite supurativa crônica de mandíbula em criança com curto período de hospitalização. Rev. Cir. Traumatol. Buco-Maxilo-Fac., 9(2), 9–16.

Rodrigues, M. F. B., Rocha, L. L. de A., Rocha, C. C. L. da, & Kussaba, S. T. (2020). Osteomielite crônica mandibular em pacientes pediátricos. Archives of Health Investigation, 9(1), 55–59. https://doi.org/10.21270/archi.v9i1.5037.

Published

05/03/2022

How to Cite

BLANCO, G. de O. .; PELISSARO, G. S. .; OLIVEIRA, J. G. P. .; MENDONÇA, J. C. G. de .; FIGUEIREDO, F. T. .; SILVA, J. C. L. da .; SANTOS, A. A. .; JARDIM, E. C. G. . Chronic osteomyelitis associated with mandibular fracture in a pediatric patient - case report. Research, Society and Development, [S. l.], v. 11, n. 3, p. e50511327004, 2022. DOI: 10.33448/rsd-v11i3.27004. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/27004. Acesso em: 16 jul. 2024.

Issue

Section

Health Sciences