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P.049 Osteomyelitis – does hyperbaric therapy help?
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Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
delayed reconstruction is the treatment of choice, especially in the more locally aggressive tumors. Prosthetic reconstruction in maxillary lesions is highly advisable due to low postoperative morbidity and almost immediate phonetic and masticatory function. Furthermore prosthetic reconstruction by an obturator allows direct visualization of the primary site for recurrence detection. A minimum of 5 year follow up is indicated to establish a disease free status in order to move to the final reconstructive phase of all patients with odontogenic myxoma. P.047 Odontoma complex of mandible: a case presentation C. Coelho, F. Cabrita, S. Sousa, C. Da Costa. Hospital de S˜ao Jos´e, Lisboa, Portugal An odontoma is a benign odontogenic tumor of mixed tissue origin that is located within the facial bones. An odontoma is usually diagnosed from a radiograph. Odontomas appear as either irregular masses of calcified material or as numerous tooth-like structures. Compound odontomas have a similarity to normal teeth and are generally found in the anterior arch (canine and incisor teeth). In the complex odontoma, there is little or no tendency to form tooth-like structures. The dentin and enamel are entwined in a mass that bears no resemblance to teeth. The result is a solid, dense mass of hard tissue and are generally found in the posterior dental arch (premolar and molar teeth). The purpose of this presentation is to show a case of complex odontoma associated with an impacted lower deciduous second molar in a 52 year old female. From the clinical presentation, complementar exams, diferencial diagnosis, treatment options and prognosis. P.048 Osteomyelitis of the jaw secondary to osteopetrosis O. Monia, K. Mrad Dali, S. Bouslama, R. Moatamri, S. Ayachi, A. Slama, H. Khochtali. Sehloul hospital, Sousse, Tunisia Objectives: Assessment of clinical, radiological patterns and treatment evaluation and Review of the literature. Methods: Records of 4 patients seen in the maxillo-facial surgery department of Sousse Tunisia. Several imaging studies were performed to assess the lesion and the adjacent bone and soft tissue structures. All patients had surgical treatment with bacteriological and histological data. Results: Four well documented cases of jaw osteitis complicating osteopetrosis were recorded: 3 men and a single women, age range: 8 and 28 years. Three lesions occurred in the mandible and 1 in the maxilla. Swelling with skin fistulae and suppuration were the most common presenting symptoms. Pathologic Mandible fracture occurred in one case. Osteitis was the first sign of osteopetrosis in two cases (8 and 12 year) and had complicated a previous osteopetrosis in tow cases. Specific signs of osteopetrosis were easily performed on standard radiographs of the skull, chest, pelvis and lumbar spine. Radiological appearance of the jaw lesions was diffuse osteosclerosis in 3 cases, dental abnormalities and sequestrum signs in all cases. Treatment consisted of appropriate antibiotic therapy, debridement of the necrotic bone and sequestrum, decortications. Radical resection of mandibular in an extensive Osteitis noted in one case. Two of our patients experienced frequent exacerbations and remissions of osteomyelitis of the mandible. The outcome of the treatment was considered good, with a complete healing of the osteomyelitic process in 2 cases over a period of 17 years. Conclusion: Jaw osteomyelitis is a serious complication of osteopetrosis. Treatment is difficult.
Abstracts, EACMFS XIX Congress P.049 Osteomyelitis – does hyperbaric therapy help? B. Dobie˙zn´ ska1 , B. Dobiezynska1 , T. Tomaszewski1 , J. Wojciechowicz1 , J. Kot1,2 . 1 Department of Maxillofacial Surgery, Medical University Lublin, Poland; 2 Medical University of Gdansk, Centrum of Marine and Tropical Medicine – Department of Hyperbaric Medicine, Gdynia, Poland Introduction: The origins of hyperbaric medicine are closely tide to diving medicine. Therapeutic application of pure oxygen above atmospheric pressure, has been used since the 1960s. Hyperbaric oxygen has found a role as adjunctive therapy in treatment of air and gas embolism, carbon monoxide poisoning, gas gangrene, as well as exceptional blood loss and crush injuries, chronic condition include chronic leg ulcer, necrotizing soft tissue infection, osteomyelitis, radionecrosis, falling skin grafts and flaps, some thermal burns and possible diabetic limb disease. Osteomyelitis is one of the oldest diseases know. It took many years before the acute infection could be brought under control with antibiotics and chronic osteomyelitis remains difficult to manage. Oxygen tension in osteomyelitis bone is low rarely exceeding 25 mmHg of oxygen, whereas oxygen tension in the normal bone is 45 mmHg. Hyperbaric oxygen therapy increase the oxygen tension to 104 mmHg in osteomyolitis bone, and to 322 mmHg in normal bone. Patients and Methods: In our work we present patients with chronic jaw osteomyelitis treated in our Department of Maxillofacial Surgery whose as additional treatment recieved HBO therapy. Diagnosis of osteomyelitis was based on histopathological bone examination. One of the patient was diagnosed with osteomyelitis in Lym disease. All patients undergone multiple antibiotics treatments before and during HBO therapy. Conclusion: The study was concluded on small number of patients, however the results suggest that HBO therapy is promising option for osteomyelitis treatment. P.050 Peripheral giant cell granuloma of the mandible A. Del Amo, C. Navarro, M. Escrig, J. Fernandez-Alba. Department of Oral and Maxillofacial Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain Peripheral giant cell granuloma is a benign lesion of unknown etiology with a common incidence in young women. Clinically manifests as an asymptomatic lesion most commonly in the mandibular bone with radiographic features of uni or multilocular images, with root resorption and cortical bone erosion in aggressive types. Macroscopically giant cell granulomas may be confused with malignant entities such as epidermoid carcinoma. Management of this disease ranges from surgical treatment to intralesional calcitonin or corticoids. We present the case of an old woman with a long term mandibular swelling with teeth movility diagnosed with a biopsy as peripheral giant cell granuloma. Surgical treatment was performed for a complete resection of the tumor and a reconstruction plate was placed to reinforce the remaining mandible. Nowadays, surgery is the treatment of choice and a correct histological diagnosis is mandatory due to the conservative treatment compared with malignant tumors. P.051 Rare lytic lesion of facial bone during the coures of acute lymphoblastic leucemia B. Dobiezynska1 , J. Wojciechowicz1 , T. Tomaszewski1 , M. Wach2 , A. Dmoszynska2 . 1 Department of Maxillofacial Surgery Medical University, Lublin, Poland; 2 Department of Hematooncology and Bone Marrow Transplantation, Medical University Lublin, Poland Introduction: Acute lymphoblastic leucemia is heterogeneous group of lymphoid disorders that results from a monoclonal proliferation and expantion of immature lymphoid cell in bone
Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1
delayed reconstruction is the treatment of choice, especially in the more locally aggressive tumors. Prosthetic reconstruction in maxillary lesions is highly advisable due to low postoperative morbidity and almost immediate phonetic and masticatory function. Furthermore prosthetic reconstruction by an obturator allows direct visualization of the primary site for recurrence detection. A minimum of 5 year follow up is indicated to establish a disease free status in order to move to the final reconstructive phase of all patients with odontogenic myxoma. P.047 Odontoma complex of mandible: a case presentation C. Coelho, F. Cabrita, S. Sousa, C. Da Costa. Hospital de S˜ao Jos´e, Lisboa, Portugal An odontoma is a benign odontogenic tumor of mixed tissue origin that is located within the facial bones. An odontoma is usually diagnosed from a radiograph. Odontomas appear as either irregular masses of calcified material or as numerous tooth-like structures. Compound odontomas have a similarity to normal teeth and are generally found in the anterior arch (canine and incisor teeth). In the complex odontoma, there is little or no tendency to form tooth-like structures. The dentin and enamel are entwined in a mass that bears no resemblance to teeth. The result is a solid, dense mass of hard tissue and are generally found in the posterior dental arch (premolar and molar teeth). The purpose of this presentation is to show a case of complex odontoma associated with an impacted lower deciduous second molar in a 52 year old female. From the clinical presentation, complementar exams, diferencial diagnosis, treatment options and prognosis. P.048 Osteomyelitis of the jaw secondary to osteopetrosis O. Monia, K. Mrad Dali, S. Bouslama, R. Moatamri, S. Ayachi, A. Slama, H. Khochtali. Sehloul hospital, Sousse, Tunisia Objectives: Assessment of clinical, radiological patterns and treatment evaluation and Review of the literature. Methods: Records of 4 patients seen in the maxillo-facial surgery department of Sousse Tunisia. Several imaging studies were performed to assess the lesion and the adjacent bone and soft tissue structures. All patients had surgical treatment with bacteriological and histological data. Results: Four well documented cases of jaw osteitis complicating osteopetrosis were recorded: 3 men and a single women, age range: 8 and 28 years. Three lesions occurred in the mandible and 1 in the maxilla. Swelling with skin fistulae and suppuration were the most common presenting symptoms. Pathologic Mandible fracture occurred in one case. Osteitis was the first sign of osteopetrosis in two cases (8 and 12 year) and had complicated a previous osteopetrosis in tow cases. Specific signs of osteopetrosis were easily performed on standard radiographs of the skull, chest, pelvis and lumbar spine. Radiological appearance of the jaw lesions was diffuse osteosclerosis in 3 cases, dental abnormalities and sequestrum signs in all cases. Treatment consisted of appropriate antibiotic therapy, debridement of the necrotic bone and sequestrum, decortications. Radical resection of mandibular in an extensive Osteitis noted in one case. Two of our patients experienced frequent exacerbations and remissions of osteomyelitis of the mandible. The outcome of the treatment was considered good, with a complete healing of the osteomyelitic process in 2 cases over a period of 17 years. Conclusion: Jaw osteomyelitis is a serious complication of osteopetrosis. Treatment is difficult.
Abstracts, EACMFS XIX Congress P.049 Osteomyelitis – does hyperbaric therapy help? B. Dobie˙zn´ ska1 , B. Dobiezynska1 , T. Tomaszewski1 , J. Wojciechowicz1 , J. Kot1,2 . 1 Department of Maxillofacial Surgery, Medical University Lublin, Poland; 2 Medical University of Gdansk, Centrum of Marine and Tropical Medicine – Department of Hyperbaric Medicine, Gdynia, Poland Introduction: The origins of hyperbaric medicine are closely tide to diving medicine. Therapeutic application of pure oxygen above atmospheric pressure, has been used since the 1960s. Hyperbaric oxygen has found a role as adjunctive therapy in treatment of air and gas embolism, carbon monoxide poisoning, gas gangrene, as well as exceptional blood loss and crush injuries, chronic condition include chronic leg ulcer, necrotizing soft tissue infection, osteomyelitis, radionecrosis, falling skin grafts and flaps, some thermal burns and possible diabetic limb disease. Osteomyelitis is one of the oldest diseases know. It took many years before the acute infection could be brought under control with antibiotics and chronic osteomyelitis remains difficult to manage. Oxygen tension in osteomyelitis bone is low rarely exceeding 25 mmHg of oxygen, whereas oxygen tension in the normal bone is 45 mmHg. Hyperbaric oxygen therapy increase the oxygen tension to 104 mmHg in osteomyolitis bone, and to 322 mmHg in normal bone. Patients and Methods: In our work we present patients with chronic jaw osteomyelitis treated in our Department of Maxillofacial Surgery whose as additional treatment recieved HBO therapy. Diagnosis of osteomyelitis was based on histopathological bone examination. One of the patient was diagnosed with osteomyelitis in Lym disease. All patients undergone multiple antibiotics treatments before and during HBO therapy. Conclusion: The study was concluded on small number of patients, however the results suggest that HBO therapy is promising option for osteomyelitis treatment. P.050 Peripheral giant cell granuloma of the mandible A. Del Amo, C. Navarro, M. Escrig, J. Fernandez-Alba. Department of Oral and Maxillofacial Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain Peripheral giant cell granuloma is a benign lesion of unknown etiology with a common incidence in young women. Clinically manifests as an asymptomatic lesion most commonly in the mandibular bone with radiographic features of uni or multilocular images, with root resorption and cortical bone erosion in aggressive types. Macroscopically giant cell granulomas may be confused with malignant entities such as epidermoid carcinoma. Management of this disease ranges from surgical treatment to intralesional calcitonin or corticoids. We present the case of an old woman with a long term mandibular swelling with teeth movility diagnosed with a biopsy as peripheral giant cell granuloma. Surgical treatment was performed for a complete resection of the tumor and a reconstruction plate was placed to reinforce the remaining mandible. Nowadays, surgery is the treatment of choice and a correct histological diagnosis is mandatory due to the conservative treatment compared with malignant tumors. P.051 Rare lytic lesion of facial bone during the coures of acute lymphoblastic leucemia B. Dobiezynska1 , J. Wojciechowicz1 , T. Tomaszewski1 , M. Wach2 , A. Dmoszynska2 . 1 Department of Maxillofacial Surgery Medical University, Lublin, Poland; 2 Department of Hematooncology and Bone Marrow Transplantation, Medical University Lublin, Poland Introduction: Acute lymphoblastic leucemia is heterogeneous group of lymphoid disorders that results from a monoclonal proliferation and expantion of immature lymphoid cell in bone