CASE PRESENTATION:
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
Inj.Basalog
Cap. Zevit
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.
ON EXAMINATION:
EXTRA ORAL
Inspection- No gross asymmetry detected.
Palpation- left side submandibular lymph node palpable, non tender, fixed, 1*1 cm.
INTRA ORAL
Inspection-
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.
INVESTIGATION:
Hb- 12g/dl
Blood grouping – “O” positive
Serum electrolytes
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
LFT:
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
A/G- 1
USG Abdomen and Pelvis:
Fatty hepatomegaly with small hemangiomas in right lobe of liver.
Mild Spleenomegaly
Cholelithiasis
Neurovascular Sonography :
Carotid Vertebral + Transcranial Doppler shows Atheromatous Carotids with long segmental plaque in left CCA.
BIOPSY:
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.
TREATMENT PLAN
1. Debridement
2. Antibiotic regimen
3. FESS