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Introduction: One of the consequences of COVID-19 is the incidence of mucormycosis in the jaws and subsequent osteomyelitis in patients with undiagnosed or uncontrolled comorbidities, such as diabetes mellitus and associated immunosuppression. Case Report: A 52-year-old male patient with a history of COVID-19 two months ago presented a painful ulcerative lesion of insidious onset in the palatal raphe measuring approximately 2 mm. He referred to numbness of the palatal region of one month of evolution. During the physical examination, purulent content, multiple pustules in the anterior maxillary buccal mucosa, and mobility of upper anterior teeth were observed. The CT revealed isodense bilateral images in maxillary and ethmoidal sinuses, bone sequestrations, and partial loss of anterior vestibular cortical bone. Laboratory tests revealed no abnormality, except for HbH1c: 10.2gr/dl. The patient was hospitalized for control of newly diagnosed diabetes mellitus. Maxillary incisional biopsy was performed, and microscopic analysis showed a mixed inflammatory infiltrate, fibrin deposits with eosinophilic and birefringent ribbon-like hyphae, branched at right angles, compatible with maxillary osteomyelitis secondary to mucormycosis. The treatment started with antifungal and intravenous antibiotics, followed by surgical cleaning under general anesthesia. The patient progressed favorably. Conclusion(s): Immunosuppression resulting from COVID-19 and/or uncontrolled systemic diseases can condition the appearance of rare opportunistic microorganisms causing infections such as mucormycosis. Early diagnosis and treatment make a difference in the morbidity and mortality of patients.
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Introduction/Aims: Calcifying epithelial odontogenic tumour (CEOT) or Pindborg's tumour is a rare, benign, slow-growing dental neoplasm which is locally aggressive and can invade dentoalveolar bone with possible displacement of teeth and soft tissue. We present a case of CEOT, which was initially managed as cemento-osseous dysplasia (COD). Material(s) and Method(s): A 52-year-old Afro-Caribbean female presented with a two-month history of a left anterior maxillary swelling and examination revealed a firm, buccal mass from upper left central incisor to first premolar. Plain radiograph and computed tomography (CT) imaging revealed a dense calcified body with a lucent capsule measuring 19 x 24 x 23 mm causing displacement of adjacent teeth and expansion of the maxillary cortex, and concluded the diagnosis of COD. Biopsy was offered to the patient but she was reluctant to proceed, so she was managed conservatively according to the radiological diagnosis. Results/Statistics: During the 18-month surveillance period, the patient developed signs of infection of her anterior left maxilla and COD. CT scans showed a slight increase in the tumour size and surgical excision was postponed due to COVID-19 pandemic and resolution after oral antibiotics. After another 12 months, a biopsy of the bony mass was carried out due to overlying mucosal erythematous and nodular changes. The histology confirmed CEOT. Conclusions/Clinical Relevance: Radiological diagnosis is often helpful and tissue biopsy is key when adverse signs are detected. Clinicians should be aware of CEOT as a differential diagnosis for any slow-growing bony lesion which appears mixed radiolucent and radiopaque on imaging. Copyright © 2022
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The proceedings contain 79 papers. The topics discussed include: vertebral fractures increase the risk of subsequent vertebral fractures: results from a large German health insurance dataset;analysis of bone architecture using fractal-based TX-Analyzer in adult patients with osteogenesis imperfecta;bone health in nursing home residents in Germany - do we care enough?;types of therapeutic errors in the management of osteoporosis: results of an experimental study;cysteine-rich angiogenic inducer 61 as a tool to efficiently enrich myeloid angiogenic cells from peripheral blood;response of bone tissue to ostarine treatment and/or treadmill exercise in a healthy adult rat model;influence of the cell aggregation technique on the differentiation of human articular chondrocytes in microtissues;changes in dispensing of anti-osteoporotic drugs during COVID-19 pandemic;and loss of adipogenic dickkopf-1 increases trabecular and cortical bone mass by promoting bone formation in male mice.
ABSTRACT
AIMS: During the COVID-19 pandemic, drilling has been classified as an aerosol-generating procedure. However, there is limited evidence on the effects of bone drilling on splatter generation. Our aim was to quantify the effect of drilling on splatter generation within the orthopaedic operative setting. METHODS: This study was performed using a Stryker System 7 dual rotating drill at full speed. Two fluid mediums (Videne (Solution 1) and Fluorescein (Solution 2)) were used to simulate drill splatter conditions. Drilling occurred at saw bone level (0 cm) and at different heights (20 cm, 50 cm, and 100 cm) above the target to simulate the surgeon 'working arm length', with and without using a drill guide. The furthest droplets were marked and the droplet displacement was measured in cm. A surgical microscope was used to detect microscopic droplets. RESULTS: Bone drilling produced 5 cm and 7 cm droplet displacement using Solutions 1 and 2, respectively. Drilling at 100 cm above the target produced the greatest splatter generation with a 95 cm macroscopic droplet displacement using Solution 2. Microscopic droplet generation was noticed at further distances than what can be macroscopically seen using Solution 1 (98 cm). Using the drill guide, there was negligible drill splatter generation. CONCLUSION: Our study has shown lower than anticipated drill splatter generation. The use of a drill guide acted as a protective measure and significantly reduced drill splatter. We therefore recommend using a drill guide at all times to reduce the risk of viral transmission in the operative setting. Cite this article: Bone Jt Open 2021;2(9):752-756.