Schlund Matthias, Raoul Gwenael, Ferri Joel, Nicot Romain
Resident, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille, France.
Professor, Oral and Maxillofacial Surgery Department, Roger Salengro Hospital, University Lille 2, Lille; INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, Lille, France.
J Oral Maxillofac Surg. 2017 Dec;75(12):2560.e1-2560.e7. doi: 10.1016/j.joms.2017.07.169. Epub 2017 Aug 3.
Mandibular osteomyelitis is relatively rare except in cases of osteoradionecrosis or medication-related osteonecrosis. The purpose of this case report is to highlight a rare but devastating complication of dental implant surgery.
The case of a patient who developed mandibular osteomyelitis after implant placement, which was resistant to long-term antibiotic therapy and required radical surgical treatment with fibular free flap reconstruction, is reviewed as is the related literature.
The most frequent etiologies are odontogenic and traumatic; however, hematogenous spread also exists. It usually affects patients with systemic conditions, such as diabetes mellitus, malnutrition, malignancy, or immune deficiency. The infection is usually polymicrobial. Concerning dental implant complications, the literature is comprehensive on the mechanical etiologies of implant failure and the infectious etiologies of peri-implantitis. Mandibular osteomyelitis treatment is a long and challenging process requiring long-term antibiotic therapy and multiple surgeries.
The pathophysiology and treatment of mandibular osteomyelitis are discussed.
除放射性骨坏死或药物相关性骨坏死病例外，下颌骨骨髓炎相对少见。本病例报告的目的是强调牙种植手术一种罕见但具有破坏性的并发症。
回顾了1例种植术后发生下颌骨骨髓炎的患者病例，该患者对长期抗生素治疗耐药，需要采用游离腓骨瓣重建进行根治性手术治疗，并复习相关文献。
最常见的病因是牙源性和创伤性的；然而，血行播散也存在。它通常影响患有全身性疾病的患者，如糖尿病、营养不良、恶性肿瘤或免疫缺陷。感染通常是多微生物的。关于牙种植并发症，文献对种植失败的机械性病因和种植体周围炎的感染性病因有全面的阐述。下颌骨骨髓炎的治疗是一个漫长且具有挑战性的过程，需要长期抗生素治疗和多次手术。
讨论了下颌骨骨髓炎的病理生理学和治疗方法。
