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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 aspect of BRONJ showing purulent drainage in the submental region and absence of radiographic changes.
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fig5: ((a) and (b)) Clinical aspect of BRONJ showing purulent drainage in the submental region and absence of radiographic changes.

Mentions: A 51-year-old female was referred for evaluation of a submental fistula with purulent drainage, with evolution of 7 days (Figure 5(a)). Medical history revealed breast cancer and use of pamidronate (90 mg) for the past two years. Clinical exam showed absence of all teeth and normal mucosa. No radiographic changes were observed (Figure 5(b)). Based on clinical history and findings, the diagnostic hypothesis was BRONJ. The purulent material was collected and cultured, and revealed the presence of Staphylococcus epidermidis with sensitivity to clindamycin. Based on microbiological analysis, the patient was administered 300 mg oral clindamycin for 35 days, and the use of pamidronate was discontinued. Following this period, fistula closure was observed, along with absence of drainage. The patient is currently being followed up 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 aspect of BRONJ showing purulent drainage in the submental region and absence of radiographic changes.
© Copyright Policy
Related In: Results  -  Collection

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

fig5: ((a) and (b)) Clinical aspect of BRONJ showing purulent drainage in the submental region and absence of radiographic changes.
Mentions: A 51-year-old female was referred for evaluation of a submental fistula with purulent drainage, with evolution of 7 days (Figure 5(a)). Medical history revealed breast cancer and use of pamidronate (90 mg) for the past two years. Clinical exam showed absence of all teeth and normal mucosa. No radiographic changes were observed (Figure 5(b)). Based on clinical history and findings, the diagnostic hypothesis was BRONJ. The purulent material was collected and cultured, and revealed the presence of Staphylococcus epidermidis with sensitivity to clindamycin. Based on microbiological analysis, the patient was administered 300 mg oral clindamycin for 35 days, and the use of pamidronate was discontinued. Following this period, fistula closure was observed, along with absence of drainage. The patient is currently being followed up 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