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Clinical management of suppurative osteomyelitis, bisphosphonate-related osteonecrosis, and osteoradionecrosis: report of three cases and review of the literature.

Guimarães EP, Pedreira FR, Jham BC, de Carli ML, Pereira AA, Hanemann JA - Case Rep Dent (2013)

Bottom Line: Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns.However, each condition is a separate entity, with different treatment approaches.Thus, accurate diagnosis is essential for adequate management and improved patient prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, 37130-000 Alfenas, MG, Brazil.

ABSTRACT
In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws-osteomyelitis, ORN, and BRONJ-and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

No MeSH data available.


Related in: MedlinePlus

((a) and (b)) Clinical and radiographic aspects 30 days after surgery showing almost complete healing of the operated area.
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fig3: ((a) and (b)) Clinical and radiographic aspects 30 days after surgery showing almost complete healing of the operated area.

Mentions: A 77-year-old white female was seen at the Oral Medicine Clinic of the Federal University of Alfenas (UNIFAL-MG) with an asymptomatic, smooth surfaced, normal colored tumor on the anterior mandibular alveolar ridge, with two months evolution. A drainage point with purulent material was also present (Figure 1(a)). The patient's medical history was unremarkable and no changes were noted on extraoral examination. Radiographic examination revealed osteolysis and bone sequestration on the mandibular alveolar ridge (Figure 1(b)). Based on clinical and radiographic findings, a provisional diagnosis of osteomyelitis was rendered. The patient was given amoxicillin (500 mg, three times/day) for 15 days and subsequently underwent excision of the bone sequestrum and curettage of the granulation tissue (Figure 2). The material was submitted to histopathological examination which revealed nonviable bone and a mixed inflammatory infiltrate of lymphocytes and plasma cells, confirming the diagnosis of chronic suppurative osteomyelitis. The area healed appropriately within one month (Figures 3(a) and 3(b)). The patient has been under follow-up for 5 years with no signs of recurrence.


Clinical management of suppurative osteomyelitis, bisphosphonate-related osteonecrosis, and osteoradionecrosis: report of three cases and review of the literature.

Guimarães EP, Pedreira FR, Jham BC, de Carli ML, Pereira AA, Hanemann JA - Case Rep Dent (2013)

((a) and (b)) Clinical and radiographic aspects 30 days after surgery showing almost complete healing of the operated area.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814104&req=5

fig3: ((a) and (b)) Clinical and radiographic aspects 30 days after surgery showing almost complete healing of the operated area.
Mentions: A 77-year-old white female was seen at the Oral Medicine Clinic of the Federal University of Alfenas (UNIFAL-MG) with an asymptomatic, smooth surfaced, normal colored tumor on the anterior mandibular alveolar ridge, with two months evolution. A drainage point with purulent material was also present (Figure 1(a)). The patient's medical history was unremarkable and no changes were noted on extraoral examination. Radiographic examination revealed osteolysis and bone sequestration on the mandibular alveolar ridge (Figure 1(b)). Based on clinical and radiographic findings, a provisional diagnosis of osteomyelitis was rendered. The patient was given amoxicillin (500 mg, three times/day) for 15 days and subsequently underwent excision of the bone sequestrum and curettage of the granulation tissue (Figure 2). The material was submitted to histopathological examination which revealed nonviable bone and a mixed inflammatory infiltrate of lymphocytes and plasma cells, confirming the diagnosis of chronic suppurative osteomyelitis. The area healed appropriately within one month (Figures 3(a) and 3(b)). The patient has been under follow-up for 5 years with no signs of recurrence.

Bottom Line: Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns.However, each condition is a separate entity, with different treatment approaches.Thus, accurate diagnosis is essential for adequate management and improved patient prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinic and Surgery, School of Dentistry, Federal University of Alfenas, 37130-000 Alfenas, MG, Brazil.

ABSTRACT
In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws-osteomyelitis, ORN, and BRONJ-and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

No MeSH data available.


Related in: MedlinePlus