Mukhtar Umer, Goyal Ashima, Rana Priyanka
Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Head of Department, Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Oral Biol Craniofac Res. 2024 Sep-Oct;14(5):655-661. doi: 10.1016/j.jobcr.2024.09.002. Epub 2024 Sep 12.
Early diagnosis of neonatal osteomyelitis is often challenging due to the rarity of such cases and here we are presenting 2 case reports to add to the existing deficient literature: A 15-day-old male infant presented with swelling and pus discharge from the anterior region of the mandible. Repeated culture and sensitivity tests revealed a transition from disseminated methicillin-sensitive S. aureus sepsis to methicillin-resistant sepsis. Moreover, there was swelling of the left elbow and right thigh. The Clinical diagnosis made was acute osteomyelitis of mandible associated with disseminated neonatal sepsis (LONS). A multidisciplinary approach was taken for the management by surgical debridement of the lesion alongwith removal of associated primary tooth buds, under specific antibiotic coverage. : A 20-day old male infant reported with pus discharge from upper lateral region of mouth past 10days. Personal history revealed, abscess in mother's right breast. A soft fluctuant pus pocket with draining sinus was present w.r.t.alveolar region of 54. CT revealed an osteolytic lesion of labial cortex of alveolar ridge in maxillary right first molar region. Pus specimen culture and sensitivity revealed growth of Staphylococcus aureus (MSSA). The clinical diagnosis of acute osteomyelitis of maxillawas made. Initially, antibiotics were prescribed which did not help and finally, surgical debridement accompanied by extraction of 54 tooth bud was done.
Acute osteomyelitis should always be considered as one of the differentials in infants with clinical signs of sepsis and Multidisciplinary management should be assured for the successful management of such cases.
由于新生儿骨髓炎病例罕见，早期诊断往往具有挑战性。在此，我们报告2例病例，以补充现有的不足文献：一名15日龄男婴，下颌前部出现肿胀和脓性分泌物。反复的培养和药敏试验显示，感染从播散性甲氧西林敏感金黄色葡萄球菌败血症转变为耐甲氧西林败血症。此外，左肘和右大腿也出现肿胀。临床诊断为下颌急性骨髓炎伴播散性新生儿败血症（LONS）。采用多学科方法进行治疗，在特定抗生素覆盖下，对病变进行手术清创，并切除相关的乳牙牙胚。一名20日龄男婴，在过去10天里，口腔上外侧区域有脓性分泌物。个人史显示，母亲右乳有脓肿。相对于54号牙的牙槽区域，有一个柔软波动的脓腔和引流窦。CT显示右上颌第一磨牙区域牙槽嵴唇侧皮质有溶骨性病变。脓液标本培养和药敏显示有金黄色葡萄球菌（MSSA）生长。临床诊断为上颌急性骨髓炎。最初使用抗生素治疗无效，最终进行了手术清创，并拔除了54号牙胚。
对于有败血症临床体征的婴儿，应始终将急性骨髓炎列为鉴别诊断之一，多学科管理对于此类病例的成功治疗至关重要。
