Rapidly progressing osteomyelitis of the mandible

Abstract

Acute osteomyelitis exists as a refractory disease even now, which usually exhibits systemic symptoms such as fever or malaise and local redness or swelling. The present paper describes a case of acute osteomyelitis of the mandible that was rapidly progressing without typical symptoms. The patient had liver cirrhosis, which should be one of the systemic factors that affect immune surveillance and metabolism. Actinomycotic druses and filaments were detected from the sequestrum. These were considered to play a role in the rapid progression of osteomyelitis without typical symptoms. There has been no evidence of local recurrence 24 months after surgery.

Figure 1

Clinical findings at the initial visit. (a) Close-up view of the socket in the left mandibular first molar region. (b) Panoramic radiograph showing neither abnormal consolidation nor ill-defined trabecular bone structure around the socket and clear running of the inferior alveolar arteries.

Figure 2

Overview of the clinical events and laboratory data.

Figure 3

CT scans at 14 days after the initial visit showing remarkable absorption of the cortical bone in the left mandibular molar region. (a) Axial section. (b) Coronal section.

Figure 4

Actinomycotic druses (A, H.E. stain, 200x) and filaments (B, Grocott stain, 400x) detected from the sequestrum of the fracture site.