CHRONIC OSTEOMYELITIS OF MAXILLA
A 60 year old male patient Mr.Siddegowda presented to the Department of Oral & Maxillofacial Surgery 3 months ago with a chief complaint of pain and pus discharge from the anterior part of the upper jaw since 1 year.
Presently he complains of frequent episodes of giddiness since 2 months.
MEDICAL HISTORY: Patient
is a k/c/o diabetes since 17 years,
had one episode of jaundice 7 years back and was thereafter diagnosed as Hepatitis B positive,
is a k/c/o hypertension since 6 years,
was diagnosed with TB 1 year back,
is a k/c/o anemia and thrombocytopenia associated with Evan’s syndrome.
PATIENT IS ON FOLLOWING MEDICATION:
Tab. Galvus Met 50/500mg
Inj. Insugren R
Tab. Tenofovir AF 300/25
Tab. Wysolone 10mg
Tab.Ecosprin AV 150/20
Tab. Cyra D 20mg
PAST DENTAL HISTORY:
Patient gives history of generalized mobility of teeth since 2 years following which he had multiple teeth extracted in JSS Dental College, Mysore , 3 months after which he got three more teeth extracted at a private clinic.
Inspection- No gross asymmetry detected.
Palpation- left side submandibular lymph node palpable, non tender, fixed, 1*1 cm.
Mouth opening approx. 3cm
Denuded bone present in the anterior region of the maxilla extending from 13 to 25 region.
Purulent discharge present associated with halitosis.
Blood grouping – “O” positive
1. sodium- 128mEq/L
2. potassium- 4.2 mEq/L
3. chloride- 100 mEq/L
Blood urea- 49 mg/dl
Serum Creatinine- 1.5 mg/dl
Total Bilirubin- 1.3mg/dl
Direct Bilirubin- 0.5mg/dl
SGOT- 25 U/L
SGPT- 17 U/L
ALP- 87 U/L
GGT- 106 U/L
Total Protein – 6g/dl
Albumin – 3g/dl
Globulin – 3g/dl
USG Abdomen and Pelvis:
Fatty hepatomegaly with small hemangiomas in right lobe of liver.
Neurovascular Sonography :
Carotid Vertebral + Transcranial Doppler shows Atheromatous Carotids with long segmental plaque in left CCA.
Bony tissue specimen from 24 region shows histopathological features diagnostic of Chronic Osteomyelitis of Maxilla.
CT Imaging of Brain with Facio-Maxillary region shows:
1. Bilateral maxillary sinusitis
2. Right sphenoid sinusitis
3. Deviated nasal septum to right with bony spur.
2. Antibiotic regimen