Hudson John W, Daly Austin P, Foster Michael
Professor, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN.
J Oral Maxillofac Surg. 2017 Oct;75(10):2127-2134. doi: 10.1016/j.joms.2017.03.008. Epub 2017 Mar 18.
To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution.
A retrospective review was conducted of 7 patient charts with associated radiographs from November 2010 to August 2016 treated by the first author at the University of Tennessee Medical Center (Knoxville, TN). Patients with chronic suppurative or nonsuppurative osteomyelitis of the mandible without condylar involvement or pathologic fracture were selected and treated with decortication with periosteal disruption in combination with long-term targeted antibiotic therapy.
Seven patients (3 women and 4 men; mean age, 60 yr) underwent decortication with periosteal disruption of the affected area and received at least 6 weeks of targeted intravenous antibiotics. Computed tomography was performed preoperatively and a repeat study was performed after completion of antibiotics. In each case, post-treatment imaging showed definitive resolution after treatment with decortication in concert with disruption of the inflamed hypertrophic periosteum and intravenous antibiotics.
Debridement of the infected cortical bone with restoration of the blood supply through disruption of the adjacent periosteum provided definitive resolution of mandibular osteomyelitis in the 7 patients treated. The hypothesis is that disruption of the affected adjacent periosteum reintroduces an immune-mediated response in concert with improved antibiotic delivery to and penetrance of the diseased mandible, aiding in definitive resolution. Decortication with periosteal disruption allows for preservation of the inferior alveolar nerve, maintains mandibular integrity, and obviates reconstructive surgery. Decortication with disruption of the adjacent periosteum, when combined with targeted antimicrobial therapy, produced definitive resolution of osteomyelitis as shown by postoperative imaging. It is the authors' assertion that not only decortication, but also disruption of the adjacent periosteum in combination with targeted antibiotic therapy should be considered a valid and principal therapeutic option for the surgical treatment of osteomyelitis of the mandible.
评估通过手术去皮质术破坏受影响的相邻骨膜并结合长期靶向抗生素治疗下颌骨骨髓炎的疗效。假设是，通过去除颊侧皮质板并破坏肥厚性炎症相邻骨膜，骨髓骨将与出血组织以及循环免疫因子和抗生素接触，这将促进彻底治愈。
对2010年11月至2016年8月期间田纳西大学医学中心（田纳西州诺克斯维尔）第一作者治疗的7例患者病历及相关X线片进行回顾性研究。选择患有慢性化脓性或非化脓性下颌骨骨髓炎且未累及髁突或病理性骨折的患者，采用去皮质术联合骨膜破坏术并结合长期靶向抗生素治疗。
7例患者（3名女性和4名男性；平均年龄60岁）接受了受影响区域的去皮质术联合骨膜破坏术，并接受了至少6周的靶向静脉抗生素治疗。术前进行了计算机断层扫描，抗生素治疗完成后进行了重复检查。在每种情况下，治疗后影像学显示，去皮质术联合破坏炎症肥厚骨膜及静脉抗生素治疗后获得了彻底治愈。
通过破坏相邻骨膜恢复血供来清创感染的皮质骨，为7例接受治疗的患者的下颌骨骨髓炎提供了彻底治愈。假设是，破坏受影响的相邻骨膜可重新引入免疫介导反应，同时改善抗生素向下颌骨疾病部位的递送和渗透，有助于彻底治愈。去皮质术联合骨膜破坏术可保留下牙槽神经，维持下颌骨完整性，避免重建手术。如术后影像学所示，去皮质术联合破坏相邻骨膜并结合靶向抗菌治疗可使骨髓炎获得彻底治愈。作者认为，不仅去皮质术，而且破坏相邻骨膜并结合靶向抗生素治疗应被视为下颌骨骨髓炎手术治疗的一种有效且主要的治疗选择。
