Osteomyelitis of the Jaw in COVID-19 Patients: A Rare Condition With a High Risk for Severe Complications

Abstract

Osteomyelitis of the jaw is an uncommon infection that arises from the flora of the oral cavity or sinuses and affects immunocompromised and polymorbid patients. Treatment includes surgical debridement and long regiments of broad-spectrum antibiotics. We present three cases of complicated jaw osteomyelitis presented with concurrent COVID-19 infection, including only two reported cases of odontogenic COVID-related osteomyelitis. The two mandibular cases were patients in their 30s with no comorbidities. The first case was an asymptomatic COVID-19-positive patient who developed an odontogenic infection after tooth extraction that was complicated by the second bout of abscess formation and localized osteomyelitis. The second case was a COVID-19-positive patient with an odontogenic infection that presented as airway compromise due to trismus and neck edema, which required an emergency tracheotomy. He developed osteomyelitis of the mandibular ramus that was reconstructed with a titanium plate. The third case was a polymorbid post-COVID-19 patient who developed a protracted infection of the maxillary sinus that resulted in the loss of an eye, destruction of the maxilla, palate, and parts of nasal cavum, and oronasal incontinence. The defect was reconstructed with a microvascular anterolateral thigh flap. We hypothesize that COVID-19-related immune dysfunction and microvascular changes contributed to osteomyelitis in our patients.

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“…Management of third molar pathology requires both accurate imaging 9 and appropriate surgical techniques to reduce the likelihood of developing complications and their manifestations [10][11][12][13][14][15] . Imaging analysis of the jawbone and condition of neighboring soft tissues requires correct understanding of the anatomy and the pathological effects on anatomical structures.…”

The correlation between the main pathogenic bacteria and bone metabolism markers in mandibular osteomyelitis

“…According to statistics, the global incidence of mandibular osteomyelitis is approximately 3-4 per 100,000 population [1]. Based its etiology, it can be classified into infectious and non-infectious osteomyelitis, with the majority of cases being caused by bacterial infections [2,3,4]. Previous studies have shown that bacteria can induce local abnormalities in bone metabolism, playing a significant role in the formation of necrotic bone However, whether local bacteria in mandibular osteomyelitis can also lead to systemic abnormalities in bone metabolism is currently unknown.…”

Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19

“…Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation (2,3). Odontogenic infections are considered the most frequent causative factor; however, other factors have also been observed in this disease: trauma, previous endodontic, periodontics infections, surgical procedures, radiation-based treatments, chemotherapeutic treatment, HIV, diabetes, anemia, leukemia, osteoporosis, malnutrition, Paget disease, fluorosis, and alcoholism (3)(4)(5). A clinical exploration will be always the best diagnostic tool; however, KEYWORDS: Actinomyces; Bilateral maxillectomy; COVID-19; Osteomyelitis.…”