JOURNAL OF DENTAL SCIENCES

Volume 2 Issue 1

UNUSUAL COMPLICATION OF A DENTAL EXTRACTION : OSTEOMYELITIS : A CASE REPORT

Dr. Rina Mehta Dr. Jigar Purani Dr. Kinjal Rindani Dr. Grishma Doria Dr. Jitendra Rajani
Abstract: Osteomyelitis, an inflammation of bone & its marrow contents is a sequela of periapical infection results in diffuse spread through medullary spaces with subsequent necrosis of bone. It may be acute, subacute & chronic. Here is a case of a complication of dental extractions with clinical & histopathological examination, diagnosed as chronic osteomyelitis. Keywords: Chronic osteomyelitis, Sequestrum Introduction: Osteomyelitis is an inflammation of medullary spaces and cortical surfaces that develops usually after a chronic infection that adversely affect the blood supply or lead to tissue necrosis, spread through bone to a large extent. Local conditions in the jaw can also predispose the host to a bone infection or localized osteomyelitis. Osteomyelitis of the jaws by odontogenic microorganisms1 arise as a complication of dental extractions , dental infections, traumatic jaw fracture and surgery, maxillofacial trauma and the subsequent inadequate treatment of a fracture, and/or irradiation 2,3 which usually occurs in immuno-compromised patients both locally and generally. Osteomyelitis is diagnosed & classified as acute, subacute or chronic, depending on the basis of patient's history, clinical examinations, and the surgical, radiographic findings and histopathological diagnosis.4 Case Report A 55-year-old male patient was referred to the Department of Oral and Maxillofacial Surgery, Faculty of Dental science, Nadiad, with pus discharge and swelling in upper anterior region with a history of extraction of upper teeth long back along with nasal regurgitation since 2 months. Patient was diabetic and hypertensive. The hematologic profile showed an increase in blood white cell count and Erythrocyte Sedimentation Rate. With the clinical diagnosis of chronic osteomyelitis, the patient was operated for the same and the tissue was sent for the histopathologic diagnosis. On gross examination bony tissue measured 4.5 x 4.1 x 2.4 cm and was pinkish brown in colour. (Illustration: 1)

Illustration 1 - Bony tissue measured 4.5 x 4.1 x 2.4 cm was pinkish brown in color. The histopathologic view showed necrotic bone with acute inflammatory cells. Medullary spaces were filled with inflammatory exudates. The osteoblasts bordering the bony trabaculae were destroyed, and areas of slow resorption were seen. (Illustration: 2, 3, 4)

Illustration 2 - Empty osteocytic Lacunae (40X) Lecturer Reader Professor & Head Department of Oral Pathology, Faculty of Dental Science, Dharmsinh Desai University, NADIAD - 387 001. GUJARAT Address for Correspondence : Dr. Rina Mehta Department of Oral Pathology, Faculty of Dental Science, Dharmsinh Desai University, NADIAD - 387 001. GUJARAT Contact : 98984 30174 E-mail : rgmehta13@yahoo.com 44

JOURNAL OF DENTAL SCIENCES

Volume 2 Issue 1

Illustration 3 - Dense mass of bony trabaculae exhibit many reversal & resting lines giving Pagetoid appearance with little interstitial marrow tissue (10X)

Illustration 4 - The osteoblasts bordering the bony trabuculae are destroyed, & resorption bays are seen (4X) Discussion: Osteomyelitis of the jaws is a rare inflammatory condition, which has been associated with multiple systemic diseases including diabetes, autoimmune states, malignancies, malnutrition, and acquired immunodeficiency syndrome in developed countries.5 The etiology is unknown and theories include bacterial infection , dental or bacteraemia from distant foci, vascular deficiency (localized endarteritis), or trauma. Conditions altering the vascularity of the bone such as radiation, malignancy, osteoporosis, osteopetrosis and Paget's disease predispose to osteomyelitis.6 Systemic diseases like diabetes, anaemia and malnutrition may cause concomitant alteration in host defenses profoundly resulting in hypovascularized bone which is predisposed to inflammation8 & Necrosis .

Most frequent sources are odontogenic foci, periodontal diseases , pulpal infections, extraction wounds, and infected fractures.6 Pus, fistula, and sequestration are typical clinical findings of this disease .7 Clinically and histologically Chronic Osteomyelitis may observed as an aggressive osteolytic putrefactive phase to a dry osteosclerotic phase.8 Conclusion: Chronic osteomyelitis of maxilla and mandible are associated to previous oral infections and their microbiota consists primarily of oral microorganisms, especially anaerobes. This case report demonstrates the typical features of chronic osteomyelitis. The combination of antibiotic therapy and surgical dbridement was effective in the treatment of chronic suppurative osteomyelitis. Osteomyelitis requires use of more accurate surgical techniques to remove pocket of dead necrotic bone with curettage & sufficient saucerization, known as sequestrectomy References: 1. Aitasalo K, Niinikoski J, Grenman R, Virolainen E. A modified protocol for early treatment of osteomyelitis and osteoradionecrosis of the mandible. Head Neck 1998;20:411-417. 2. Koorbusch GF, Fotos P, Goll KT. Retrospective assessment of o s t e o m y e l i t i s : E t i o l o g y, demographics, risk factors, and management in 35 cases. Oral Surg Oral Med Oral Pathol 1992;74:149154. 3. Daramola JO, Ajagbe HA. Chronic osteomyelitis of the mandible in adults: a clinical study of 34 cases. Br J Oral Surg 1982; 20:58- 62 4. Shafer's textbook of Oral Pathology 5th edition:659-696 5. Saeed Nezafati, Mohammad Ali Ghavimi , Amir Saeed Yavari. Localized Osteomyelitis of the Mandible Secondary to Dental Treatment: Report of a Case J Dent Res Dent Clin Dent Prospect Vol. 3 No. 2 spring 2009; 3(2):67-69 6. V. Patel, A. Harwood and M. McGurk Osteomyelitis presenting in two patients: a challenging disease to manage. BDJ, Vol. 209 NO. 8 Oct 23 2010 393 7. Osteomyelitis of the jaw. M. Baltensperger, G.K.Eyrich 2009, XXII,316p.537illus.,198SBN:978-3-540-28764-3 8. Oral & Maxillofacial pathology (2ndedition, Neville, Damm, Allen, Bouquot:107-135)

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