ABSTRACT
Hemoglobinopathies are by far the most common genetic diseases, affecting millions worldwide with a prevalence for natives of Iran, Southeast Asia, and the Caspian Sea, as part of the so-called Thalassemia Belt, and an overall incidence ranging approximately from 3 to 100 patients per 100,000 population. ß-Thalassemia major is of particular significance, providing bad outcomes despite aggressive therapeutic approaches. We report a case of ß-thalassemia in a 5-year-old Persian boy who presented with classical diagnostic features of the disease and who did not survive despite an aggressive management approach. A review of the clinical, radiographic, laboratory, and therapeutic characteristics as well as diagnostic tests of this disease is also presented. The multifactorial challenges that face clinicians in the management of this serious disease are also reviewed.
Subject(s)
Craniofacial Abnormalities/etiology , beta-Thalassemia/complications , Child, Preschool , Craniofacial Abnormalities/diagnostic imaging , Fatal Outcome , Humans , Male , Tomography, X-Ray ComputedABSTRACT
The key to appropriate treatment of odontogenic osteomyelitis or bisphosphonate-related osteonecrosis of the mandible in patients with autoimmune diseases lies in making the correct diagnosis based on meticulous review of signs and symptoms. As this complex case involving a patient with multiple comorbidities illustrates, diagnosis can be difficult, because these conditions may overlap or be mistaken for other conditions. However, prompt treatment is essential to limit the progression, which can be devastating for these medically complex patients. It is, therefore, important to understand local and systemic conditions that can weaken the immune system and predispose patients to chronic bone infection, meticulously go through signs and symptoms, and have a complete medical history, including patient medications.
Subject(s)
Autoimmune Diseases/complications , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnosis , Immunocompromised Host , Mandibular Diseases/diagnosis , Osteomyelitis/diagnosis , Actinobacteria/isolation & purification , Alendronate/therapeutic use , Arthritis, Rheumatoid/complications , Bone Density Conservation Agents/therapeutic use , Crohn Disease/complications , Dental Caries/surgery , Diagnosis, Differential , Female , Humans , Mandibular Diseases/microbiology , Middle Aged , Molar, Third/pathology , Osteomyelitis/microbiology , Prednisone/therapeutic use , Tooth ExtractionABSTRACT
PURPOSE: Close proximity of the inferior alveolar nerve (IAN) to mandibular third molars (MTMs) may result in nerve injury during the extraction of third molars. Alternative surgical techniques, such as coronectomy, have been suggested to decrease this risk. This study examined a new alternative technique, the pericoronal ostectomy (PO), that is intended to decrease IAN injury in high-risk cases. PATIENTS AND METHODS: This prospective clinical cohort study consisted of 14 patients with 17 MTMs in close relation to the IAN. All patients were subjected to 2- and 3-dimensional preoperative radiographic evaluations. Selected patients with mesioangular and vertical bone impactions were treated by the staged PO technique. An institutional review board approval from the University of the Pacific was given to this study. RESULTS: Because of the PO procedure, all 17 high-risk MTMs in the study erupted to a more occlusal position away from the danger zone of the IAN and were eventually removed (mean distance of eruption, 2.0 mm). Three patients reported a transient neurosensory deficit, 2 with the IAN and 1 with a lingual nerve. All 3 had a full resolution of symptoms within 3 months of the postoperative period. CONCLUSION: The PO technique appears to be an additional viable alternative technique to extraction of MTMs in intimate proximity to the IAN.
