Maxillary Osteomyelitis in a Patient with Pansinusitis and Recently Diagnosed Focal Segmental Glomerulosclerosis

Abstract

Given the rarity of osteomyelitis of the maxilla, a confirmed diagnosis requires extensive investigation into the possible underlying causes of the disease. The most common causes of osteomyelitis of the jaw are periodontal infections and sinusitis with contiguous seeding and infection of the bone. Even in those affected by these potential causes, an immunocompromised state is usually present for an extensive infection to occur. Early recognition is key for ensuring appropriate treatment and avoidance of life-threatening complications. We report a case of maxillary osteomyelitis in a patient with no clear predisposing risk factors, a history of recurrent pansinusitis, and recently diagnosed focal segmental glomerulosclerosis. Cultures of the bone revealed multiple bacterial and fungal organisms. He was treated with surgical debridement, teeth extraction, and a prolonged course of antifungals and antibiotics.

Treatment of maxillary osteomyelitis after facial trauma

“…Osteomyelitis of the maxilla is rare. It can be caused by facial trauma affecting tooth structures or causing fractures of the alveolar bone 2 . Radiographically this chronic process can be seen as areas of local radiolucency with uniform or speckled patterns besides areas of bone sequestration 3 .…”

Osteomyelitis of Jaw: A Review

“…The host defense system gets by the presence of any immunocompromising condition like Diabetes mellitus, leukemia, malnutrition, agranulocytosis, severe anemia, chronic alcoholism, drug abuse, sickle cell disease, typhoid, chemotherapy, irradiation, steroid use, hepatitis, HIV, glomerulonephritis, systemic lupus erythematosus, etc. 1,3,13 The vascularity of the host bone is altered due to therapeutic irradiation, Paget's disease, bone malignancy, fibrous dysplasia, osteoporosis, mercury; arsenic, and bismuth causing metallic bone necrosis. In the maxilla, osteomyelitis can occur due to any pansinusitis or facial cellulitis.…”

“…The organisms further proliferate in the host medium but remain protected from the host defense mechanism. 1,3,13 Etiology:…”