Jung Junhong, Kim Sumin, Park Jun-Sang, Lee Choi-Ryang, Jeon Jae-Ho, Kwon Ik-Jae, Myoung Hoon
Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea.
Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Seoul National University, Seoul, Korea.
J Dent Anesth Pain Med. 2020 Aug;20(4):251-259. doi: 10.17245/jdapm.2020.20.4.251. Epub 2020 Aug 27.
Oral and maxillofacial infection is a common complication in patients undergoing chemotherapy. The treatment of oral diseases in such patients differs from that administered to healthy patients. This paper reports a case of acute osteomyelitis of odontogenic origin following a recent chemotherapy session. The patient's condition was life-threatening because of neutropenic fever and sepsis that developed during the inpatient supportive care. However, the patient showed prompt recovery within 40 days following the use of appropriate antibiotics and routine dressing, without the requirement for surgical treatment, except tooth extraction. As seen in this case, patients undergoing chemotherapy are more susceptible to rapid progression of infections in the oral and maxillofacial areas. Therefore, accurate diagnosis through prompt clinical and radiological examination, identification of the extent of infection, and assessment of the patient's immune system are crucial for favorable outcomes. It is also necessary to eliminate the source of infection through appropriate administration of antibiotics. In particular, a broad-spectrum antibiotic with anti-pneumococcal activity is essential. Proper antibiotic administration and wound dressing are essential for infection control. Furthermore, close consultation with a hemato-oncologist is necessary for effective infection management based on the professional evaluation of patients' immune mechanisms.
口腔颌面部感染是化疗患者常见的并发症。此类患者口腔疾病的治疗与健康患者不同。本文报告了一例近期化疗后发生的牙源性急性骨髓炎病例。由于住院支持治疗期间出现中性粒细胞减少性发热和败血症,患者的病情危及生命。然而,在使用适当的抗生素和常规换药后,患者在40天内迅速康复,除拔牙外无需手术治疗。如本病例所示,化疗患者更容易出现口腔颌面部感染的快速进展。因此,通过及时的临床和影像学检查进行准确诊断、确定感染范围以及评估患者的免疫系统对于取得良好预后至关重要。通过适当使用抗生素消除感染源也很有必要。特别是,具有抗肺炎球菌活性的广谱抗生素至关重要。正确使用抗生素和伤口换药对于控制感染至关重要。此外,基于对患者免疫机制的专业评估,与血液肿瘤学家密切会诊对于有效管理感染是必要的。