Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction

Marschall, Jeffrey S.; Flint, Robert L.; Kushner, George M.; Alpert, Brian

doi:10.1016/j.joms.2019.01.036

Cited by 24 publications

(25 citation statements)

References 21 publications

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“…Despite advances in dental and medical care, OM persists and is of important concern in modern medicine. Consistent with the findings from previous authors, the prevalence of OM of the jaw seems to have increased recently [ 11 , 13 ]. In addition, systemic diseases like diabetes, which predisposes individuals to OM partly due to decrease in vascularity of the bone, are becoming more common [ 13 ].…”

Section: Introductionsupporting

confidence: 91%

“…Consistent with the findings from previous authors, the prevalence of OM of the jaw seems to have increased recently [ 11 , 13 ]. In addition, systemic diseases like diabetes, which predisposes individuals to OM partly due to decrease in vascularity of the bone, are becoming more common [ 13 ]. Due to the wide variety of classification systems, multiple surgical options, and unlimited options of antibiotic therapy, even the most experienced surgeons can have difficult deciding on optimal treatment for OM of the jaw.…”

Section: Introductionsupporting

confidence: 91%

“…The currently acknowledged treatment for OM of the jaw is a combination of antibiotic therapy and surgical management with hyperbaric oxygen treatment. Between 500 and 700 species of bacteria have been identified in the human mouth [ 13 ]. Therefore, it should be no surprise that OM of the jaw is a polymicrobial infection.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the wide variety of classification systems, multiple surgical options, and unlimited options of antibiotic therapy, even the most experienced surgeons can have difficult deciding on optimal treatment for OM of the jaw. Although antibiotic therapy has helped augment such treatment, surgical treatment remains the main therapeutic interventions and includes debridement, decortication, and resection [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Decompressive effects of draining tube on suppurative and sclerosing osteomyelitis in the jaw

Sodnom-Ish

Seo

et al. 2021

BMC Musculoskelet Disord

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Background Osteomyelitis (OM) in the jaw is an inflammatory disease of osseous tissue that begins in the medullary space and progressively expands to the cortical portion of the bone, the Haversian system, the periosteum and the overlying soft tissue. Despite advances in dental and medical care, OM persists and is of important concern in modern medicine. Active negative pressure is known to prevent post-operative hematoma; decrease the number of bacterial pathogens, accumulation of toxins, and necrotic tissue; and promote osteogenesis and angiogenesis with the use of a draining tube such as the Jackson-Pratt (JP) or Hemovac. The purpose of this study was to assess the effectiveness of decompression for the treatment of OM in the jaw. Methods This retrospective study included a total of 130 patients, 55 patients with sclerosing OM and 75 patients with suppurative OM were included. The radiographic bone densities expressed as a grayscale values (GSVs), were measured using an easy digitalized panoramic analysis (EDPA) method, processed on the conditional inference tree, generated by the R program® 3.2.3 with a probability of 96.8%. Rectangle annotation analysis of INFINITT PACS® (INFINITT Healthcare, Seoul, Korea) of 50 mm2 was determined as the region of interest (ROI). Student’s t-test and ANOVA were used to determine significance (p < 0.05). Results Significant changes was observed between radiographic bone density in the sclerosing type with drain and without drain at the six-month and one-year follow-up (p < 0.05). Significant difference was demonstrated between the suppurative OM with drain and without drain groups at the one-year follow-up (p < 0.05). Conclusion The OM groups with drain exhibited more enhanced bone density compared to the groups without drain at the six-month and one-year follow-ups. The drain insertion for decompression is effective for the management of sclerosing and suppurative OM. It is recommended to implement it for the management of OM.

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Section: Introductionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Decompressive effects of draining tube on suppurative and sclerosing osteomyelitis in the jaw

Sodnom-Ish

Seo

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…A number of reports have demonstrated successful immediate mandibular reconstruction in cases of benign disease, including the present case, as well as in cases of acute or chronic infection. 21,27,29,32,33 In one of the earliest and most cited evaluations of simultaneous resection and reconstruction, Obwegeser 33 demonstrated success in intraoral approach for immediate mandibular reconstruction in patients with both benign disease and gross infection. He emphasized that absolute immobilization coupled with wellapproximated, tension-free soft-tissue closure, and with antibiotic treatment, as applicable, are essential for success.…”

Section: Discussionmentioning

confidence: 99%

Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

Alfi

Hassan

East

et al. 2021

FACE

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Reconstruction of large segmental mandibular defects presents a challenge for oral and maxillofacial surgeons, particularly in the skeletally immature pediatric patient. Autogenous bone graft is historically preferred; however, harvest of autograft requires a second surgical site, risking donor-site complications as well as the potential for long-term complications in the growing child. Here, we present the first known report of a pediatric patient who underwent immediate mandibular reconstruction of a 6.5-cm long segmental defect using a cellular bone allograft (VF-CBA) combined with custom-fabricated guides and plates following tumor resection. The use of VF-CBA, along with the custom guides and plates, eliminated the need for autograft harvest in a child, enabled an entirely intraoral approach, avoiding the creation of a cutaneous scar, and reduced the total operative time, resulting in a fast recovery and improved patient satisfaction. By 7 months postoperative, the patient’s mandible was fully healed with solid osseous consolidation. These results support VF-CBA combined with custom intraoral guides and plates as an effective treatment option for reconstruction of large segmental mandibular defects in a pediatric patient.

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Local treatment of experimental mandibular osteomyelitis with an injectable biomimetic gentamicin hydrogel using a new rabbit model

et al. 2021

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Mandibular osteomyelitis (OM) is a challenging disease. Our objective was to assess a new OM model in rabbits induced by arsenic trioxide and to assess the efficacy of local treatment of OM using injectable gentamicin‐collagen hydrogels (GNT‐COLL). OM was induced unilaterally by controlled confinement of arsenic trioxide paste to the root canal of lower incisors of rabbits, while OM progression was characterized for 16 weeks. On the other hand, two injectable COLL hydrogels functionalized with GNT were prepared and characterized for physicochemical properties; a simple GNT‐COLL and a nanohydroxyapatite (nHA)‐ loaded hydrogel (GNT‐COLL/nHA). The two hydrogels were evaluated to treat OM model, while a multidose intramuscular GNT solution served as positive control. Outcomes were assessed by standard methods at 4 and 12 weeks post‐surgery. The clinical, radiographical, and histopathological findings provided evidence for the validity of the arsenic‐induced OM. The results demonstrated that a single intra‐lesional injection of the two hydrogels was more suppressive to OM compared to multidose systemic GNT. The composite GNT‐COLL/nHA hydrogel proved to induce early preservation of alveolar bone (ridge) length and higher amount of bone area\total area at 4 weeks (40.53% ± 2.34) followed by GNT‐COLL (32.21% ± 0.72). On the other hand, the positive control group revealed the least ridge length and bone area\total area (26.22% ± 1.32) at 4 weeks. Both hydrogels successfully arrested OM with no signs of recurrence for up to 12 weeks. Therefore, results support the greater advantages of the composite hydrogel as an osteogenic/antibiotic delivery system in OM treatment.

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Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction

Cited by 24 publications

References 21 publications

Decompressive effects of draining tube on suppurative and sclerosing osteomyelitis in the jaw

Decompressive effects of draining tube on suppurative and sclerosing osteomyelitis in the jaw

Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

Local treatment of experimental mandibular osteomyelitis with an injectable biomimetic gentamicin hydrogel using a new rabbit model

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