Radical surgical approach to chronic suppurative osteomyelitis: Case report / Abordaje quirúrgico radical de una osteomielitis crónica supurativa: reporte de caso

Abstract Diabetes mellitus is a systemic condition potentially related to an increased risk of progression of various infections such as chronic osteomyelitis by accelerating the inflammatory process with bone tissue necrosis and suppuration. Therefore, if there is no proper management of these infections, they can be life-threatening as they spread to deeper spaces in the head and neck. We describe the case of a 52-year-old male patient with a history of diabetes mellitus and grade III osteoarthritis who was diagnosed with chronic suppurative osteomyelitis of the mandible. He underwent a multidisciplinary surgical intervention in which he underwent a hemimandibulectomy with immediate mandibular reconstruction. The present case highlights the importance of early and radical treatment of patients with chronic suppurative osteomyelitis of the mandible and systemic comorbidities. In addition, this case presents a review of diabetes mellitus and the risk of developing odontogenic infections and complications when invading deeper spaces in the head and neck. Therefore, in this population, careful planning is required for early surgical and pharmacological treatment.

Resumen La diabetes mellitus es una condición sistémica potencialmente relacionada con un mayor riesgo de progresión de diversas infecciones como la osteomielitis crónica al acelerar el proceso inflamatorio con necrosis del tejido óseo y supuración. Por lo tanto, si no hay un manejo adecuado de estas infecciones pueden ser potencialmente mortales al llegar a propagarse a espacios más profundos de la cabeza y cuello. Describimos el caso de un paciente varón de 52 años con antecedentes de diabetes mellitus y osteoartrosis grado III a quien se le diagnosticó de osteomielitis crónica supurativa mandibular. Se le realizó una intervención quirúrgica multidisciplinaria en la cual se le realizó una hemimandibulectomía con reconstrucción mandibular inmediata. El presente caso destaca la importancia del tratamiento temprano y radical de los pacientes con osteomielitis mandibular crónica supurativa y comorbilidades sistémicas. Además, en este caso se presenta una revisión sobre la diabetes mellitus y el riesgo de desarrollar infecciones odontogénicas y complicaciones al invadir espacios más profundos de la cabeza y cuello. Por lo tanto, en esta población se requiere de una planificación cuidadosa para realizar un tratamiento quirúrgico y farmacológico temprano.

Synergistic anti-inflammatory effect of NSAIDs plus B vitamins administered pre and postoperatively in third molar surgery: randomized clinical trial / Efeito anti-inflamatório sinérgico da associação de AINEs e vitaminas do complexo B administrada no pré e pós-operatório de cirurgia de terceiros molares: ensaio clínico randomizado

Objective : The aim of the present study was to evaluate the synergistic anti-inflammatory effect of Non-steroidal anti-inflammatory drugs (NSAIDs) plus B vitamins administered pre and postoperatively in surgeries of impacted mandibular third molars. Material and Methods : Double-blind randomized clinical trial, sixty-six patients participated and were randomized into 2 groups. The control group was administered meloxicam 15 mg intramuscularly plus placebo orally and to the experimental group, meloxicam 15 mg intramuscularly plus vitamins B [B1, B6, and B12] orally; both treatments were administered preoperatively. The anti-inflammatory effect was evaluated by pain intensity, facial swelling (facial contour measurements), and mouth opening (distance between the upper and lower incisors) during the post-surgical phase. Student's t-test was performed for independent samples. Results : In all the evaluated times (1 hour, 6 hours, 12 hours, 24 hours, 2 days, and 3 days after the end of the surgery) the experimental group presented a significantly lower intensity of pain compared to the control group (p<0.05). The highest pain intensity was recorded at 6 hours (17.7 ± 9.1 mm in the experimental group and 34.5 ± 21.3 mm in the control group). Swelling and mouth opening were similar in both groups, at all times evaluated (p>0.05). Conclusion : In the present study, the administration of NSAIDs plus B vitamins (B1, B6, B12) produced lower intensity of pain compared to the administration of only NSAIDs. Nevertheless, swelling and mouth opening were similar in all evaluations for both study groups (AU)

Objetivo : O objetivo do presente estudo foi avaliar o efeito anti-inflamatório sinérgico de anti-inflamatórios não esteroidais (AINEs) com vitaminas do complexo B administrados no pré e pós-operatório de cirurgias de terceiros molares inferiores impactados. Material e Métodos: Ensaio clínico randomizado duplo-cego, 66 participantesque foram randomizados em 2 grupos. O grupo controle recebeu Meloxicam 15 mg por via intramuscular + placebo por via oral e o grupo experimental, Meloxicam 15 mg por via intramuscular + vitaminas B [B1, B6 e B12] por via oral; ambos os tratamentos foram administrados no pré-operatório. O efeito anti-inflamatório foi avaliado pela intensidade da dor, edema facial (medidas do contorno facial) e abertura da boca (distância entre os incisivos superiores e inferiores) durante a fase pós-cirúrgica. Foi aplicado o teste t de Student para amostras independentes. Resultados: Em todos os tempos avaliados (1 hora, 6 horas, 12 horas, 24 horas, 2 dias e 3 dias após o término da cirurgia) o grupo experimental apresentou uma intensidade de dor significativamente menor em relação ao grupo controle (p <0,05). A maior intensidade de dor foi registrada em 6 horas (17,7 ± 9,1 mm no grupo experimental e 34,5 ± 21,3 mm no grupo controle). Edema e abertura bucal foram semelhantes nos dois grupos, em todos os momentos avaliados (p>0,05). Conclusão: No presente estudo, a administração de AINEs com vitaminas do complexo B (B1, B6, B12) resultou em menor intensidade de dor em comparação com a administração apenas de AINEs. No entanto, o edema e a abertura da boca foram semelhantes em todas as avaliações para ambos os grupos de estudo (AU).

Quiste dentígero asociado a tercer molar inferior sobreinfectado por actinomices. Reporte de Caso / Dentigerous cyst associated with mandibular third molar superinfected by Actinomyces: Case Report

Se reporta el caso de una paciente de 14 años de edad que presentaba una lesión dolorosa ubicada a nivel del cuerpo mandibular derecho en la zona de molares. Al examen clínico se observa una tumoración crepitante y dolorosa a la palpación. Al estudio imaginológico se sospechó de una lesión quística o tumoral de origen odontogánico, se realizó una biopsia por punzo aspiración y en el examen an tomo patológico se observaron colonias de actinomices con lo cual se concluyó con el diagnóstico de quiste dentígero sobreinfectado por Actinomices. Este tipo de quiste est  asociado frecuentemente a terceras molares y es sometido a enucleación en la mayoría de los casos, pero al estar sobre infectado por una bacteria endógena de la cavidad oral requiere de tratamiento farmacológico por un tiempo prolongado. Es importante resaltar en este caso la importancia de la punzo aspiración antes del tratamiento definitivo.

A 14 year old case is reported who had a painful lesion located at the level of the right mandibular body in the molars. Clinical examination showed a crepitant and painful tumor on palpation. On imaging studies a cystic lesion or tumor of odontogenic origin are suspected, a biopsy was performed by puncture aspiration and on anatomopathological examination actinomyces colonies were observed so dentigerous cyst superinfected by actinomyces as diagnosis is concluded. This type of cyst is oft en associated third molars and is subjected to enucleation in most cases, but being infected by an oral cavity endogenous bacteria requires drug therapy for a prolonged time. So is important in this case emphasize the aspiration puncture importance before definitive therapy.

Osteomielitis mandibular por actinomices: Reporte de caso / Mandibular osteomyelitis by actinomyces: Case report

Se reporta el caso de un paciente varón de 27 años con antecedente de exodoncia compleja de la tercera molar mandibular inferior derecha que presentaba una tumefacción circunscrita dolorosa en la región submandibular ipsilateral. En el estudio imaginológico, la radiografía panorámica presentaba un proceso osteolítico periapical e interradicular con un patrón osteogénico circundante por lo que se utilizó como complemento una tomografía cone beam, en donde se evidenció compromiso desde la rama mandibular derecha hasta la sínfisis mandibular. Las lesiones a nivel de tejidos blandos y tejidos duros fueron diagnosticadas y manejadas como una actinomicosis cervicofacial y osteomielitis crónica supurativa respectivamente. El conocimiento de las diferentes infecciones bacterianas, un adecuado análisis clínico y estudio imaginológico nos darán la pauta para la correcta terapéutica de las distintas patologías maxilofaciales.

A Case of a 27-years old male with a history of complex extraction of right mandibular third molar that had a painful circumscribed swelling in the ipsilateral submandibular region. In imaging studies, the ortopantograph showed a periapical and interradicular osteolytic process with a osteogenic pattern surrounding, so we used a Cone beam Tomography as complement where we found commitment from the right ramus to the mandibular symphsis. Damage at soft and hard tissue were diagnosed and managed as a cervicofacial actinomycosis and supurative chronic osteomyelitis respectively. The knowledge of different bacterial infections, appropriate clinical analysis and imaging studies will lead us to the correct therapy of various maxillofacial pathologies.