Kvolik Pavić Ana, Zubčić Vedran
Department of Maxillofacial and Oral Surgery, Osijek, Croatia.
Faculty of Medicine, Osijek Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
Front Surg. 2022 Jul 1;9:867088. doi: 10.3389/fsurg.2022.867088. eCollection 2022.
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.
颌骨骨髓炎是一种罕见的感染性疾病，由口腔或鼻窦菌群引起，影响免疫功能低下和患有多种疾病的患者。治疗方法包括手术清创和长期使用广谱抗生素。我们报告了三例并发COVID-19感染的复杂性颌骨骨髓炎病例，其中仅两例为牙源性COVID相关骨髓炎。两例下颌骨病例为30多岁无合并症的患者。第一例是一名无症状的COVID-19阳性患者，拔牙后发生牙源性感染，并发第二次脓肿形成和局限性骨髓炎。第二例是一名COVID-19阳性患者，患有牙源性感染，因牙关紧闭和颈部水肿导致气道受压，需要紧急气管切开术。他发生了下颌支骨髓炎，并用钛板进行了重建。第三例是一名COVID-19后的多病患者，上颌窦发生了迁延性感染，导致失明、上颌骨、腭部和部分鼻腔破坏以及口鼻失禁。缺损用股前外侧游离皮瓣进行了重建。我们推测，COVID-19相关的免疫功能障碍和微血管变化导致了我们患者的骨髓炎。
