Oğütcen-Toller Melahat, Tek Mustafa, Sener Ismail, Bereket Cihan, Inal Samet, Ozden Bora
Faculty of Dentistry, Departments of Oral Pathology and Oral and Maxillofacial Surgery, Ondokuz Mayis University, Samsun, Turkey.
J Oral Maxillofac Surg. 2010 Jan;68(1):167-75. doi: 10.1016/j.joms.2005.07.022.
Osteopetrosis (OP), also known as Albers-Schönberg disease, is a rare metabolic bone disease caused by a congenital defect in the development or function of the osteoclasts resulting in generalized increase in skeletal mass. Osteomyelitis is a recognized complication, and prevention of dental infections can be difficult. The locations of osteomyelitis in the jawbones have been either in the mandible or maxilla. In this article, a case of OP complicated with osteomyelitis of the mandible and the maxilla is presented, and types of OP and treatment options are discussed with a literature review.
The 18-year-old blind female patient had been diagnosed with OP in the past. She had a purulent discharge at the medial canthus of the left eye, in addition to another discharge of pus in the infraorbital and upper left molar region, and multiple malformed and partially impacted teeth, and there were sequestrum formations in the maxilla and mandible. For the treatment of osteomyelitis, systemic combined antibiotics of sultamicillin 750 mg and ornidazole 500 mg twice daily, were given orally for 5 weeks followed by surgical removal of small sequestra in the jaws. Persistent osteomyelitic bones were removed by saucerization in the mandibular anterior and right premolar region and the left posterior maxilla under the same antibiotic regimen. After wound healing was completely achieved in both jaws, the oroantral opening in the left posterior maxilla was successfully closed with a buccal flap under antibiotic coverage.
The purulent discharge at the medial canthus of her left eye subsided and she had no recurrent infections during the long-term follow-up of 2 years.
The case reported shows that osteomyelitis is difficult to treat in subjects suffering from OP. Therefore, it is necessary to be very cautious against infections in even minor surgical interventions such as simple dental extractions in patients with OP, regardless of the location of the teeth. When considering removal of impacted teeth in the posterior maxilla, resultant oroantral communication from osteomyelitis of the extraction site should be regarded as a potential complication.
骨质石化症（OP），也称为阿尔伯斯-尚伯格病，是一种罕见的代谢性骨病，由破骨细胞发育或功能的先天性缺陷引起，导致骨骼质量普遍增加。骨髓炎是一种公认的并发症，预防牙齿感染可能很困难。颌骨骨髓炎的发病部位要么在下颌骨，要么在上颌骨。本文介绍了一例OP合并下颌骨和上颌骨骨髓炎的病例，并结合文献复习讨论了OP的类型和治疗选择。
这位18岁的失明女性患者过去被诊断患有OP。她左眼内眦有脓性分泌物，此外眶下和左上磨牙区域还有脓液排出，并有多颗畸形和部分阻生牙，上颌骨和下颌骨有死骨形成。为治疗骨髓炎，口服舒他西林750mg和奥硝唑500mg的全身性联合抗生素，每日两次，持续5周，随后手术切除颌骨内的小死骨。在相同抗生素治疗方案下，通过碟形手术在下颌前部和右前磨牙区域以及左上颌后部切除持续存在骨髓炎的骨质。在颌骨伤口完全愈合后，在抗生素覆盖下，用颊瓣成功封闭了左上颌后部的口腔上颌窦瘘。
她左眼内眦的脓性分泌物消退，在2年的长期随访中没有复发感染。
报告的病例表明，OP患者的骨髓炎难以治疗。因此，对于OP患者，即使是简单的拔牙等小手术干预中的感染也必须非常谨慎，无论牙齿的位置如何。在考虑拔除上颌后部的阻生牙时，拔牙部位骨髓炎导致的口腔上颌窦相通应被视为一种潜在并发症。
