Case report of osteomyelitis of the mandible in osteopetrosis and management considerations. (April 2021)

• Record Type: Journal Article
• Authors: Allal, Sarah; Rabuel, Valentin; Gengler, Charline; Douchet, Catherine; Allal, François; Zwetyenga, Narcisse
• Is Part Of: International journal of surgery case reports. Volume 81(2021)
• Publication Date: 2021-04
• Subjects: Osteomyelitis -- Mandible -- Case report -- Osteopetrosis -- Management; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105813
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Management guidelines in mandibular osteomyelitis in Osteopetrosis. A female patient with osteopetrosis presented osteomyelitis after teeth extraction. Our case suggests the importance to maintain at maximum existing mandibular bone. Dental prevention could reduce occurrence of osteomyelitis in Osteopetrosis. Abstract: Introduction and importance: Osteopetrosis is a poorly known and probably underdiagnosed pathology. It is caused by various genetic abnormalities resulting in osteoclast dysfunction. Functional and aesthetic consequences have a major impact on the patient's quality of life. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. Management of this complication remains complex and often unsatisfactory. Case presentation: We report a case of a 62-year-old woman with osteopetrosis, complicated by mandibular osteomyelitis with intra-oral bone exposure and submental fistulas. Management was performed with antibiotic therapy and surgical necrotic resection. This cured the fistulas but the bone exposure persisted. Discussion: This case report highlights the difficulty of achieving complete healing of osteomyelitis in osteopetrosis. Antibiotic therapy, surgical management, or even hyperbaric oxygen therapy are required, but must be adapted to the case. A free flap procedure is undesirable but, when it is necessary, a bone marrow transplant could be considered to restore osteoclast function. Conclusion: The management of mandibular osteomyelitis in patients with osteopetrosis must adapt to the situation and severity. To avoid most cases of osteomyelitic complications in patients suffering from osteopetrosis, we propose that a preventive strategy of better dental care should be considered.