DOCSLIB.ORG

Septic Osteitis and Osteomyelitis in Foals – Are Antimicrobials Alone Enough? C

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Septic Osteitis and Osteomyelitis in Foals – Are Antimicrobials Alone Enough? C EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2013 67 Clinical Commentary Septic osteitis and osteomyelitis in foals – are antimicrobials alone enough? C. Koch* and S. Witte Equine Clinic and Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Bern, Bern, Switzerland. *Corresponding author: email: [email protected] Keywords: horse; foal; septic osteitis; septic osteomyelitis; medical treatment; doxycycline Introduction fibrinogen concentrations and blood cultures, however, can The case report by Lawrence and Fraser (2013) describes the be helpful in diagnosing O/OM (Sayegh et al. 2001; Newquist successful management of 2 weanlings with septic osteitis of and Baxter 2009). the proximal sesamoid bones, using prolonged (6 weeks) Radiography is most commonly used to confirm and follow antimicrobial therapy alone. Doxycycline, an antimicrobial a septic bone lesion. Bone lysis may not be recognised with excellent bone penetration properties, was deemed radiographically until at least 4–5 days post infection, at a time essential to treatment success. In contrast to the poor when the bone has lost 30–50% or more of its mineral content outcome in previously reported cases of septic sesamoid bone (Turner 1987; Bramlage 1998; Goodrich and Nixon 2004). In osteitis, the authors were able to show the value of a cases with concurrent infarction, this time lag may be as great conservative approach over surgical debridement. The as 2–3 weeks (Wegener and Alavi 1991; Bertone 1999). question is to what extent are we able to extrapolate this to Delayed diagnosis and associated extensive lysis may result in the general treatment of septic osteitis and osteomyelitis in pathological fracture, with a negative impact on prognosis young horses? (Fig 1). Advanced imaging (magnetic resonance imaging [MRI] or computed tomography [CT]) may allow earlier recognition (Sayegh et al. 2001; Easley et al. 2011) and provide Etiopathological, clinical, and information on the extent of the lesion (Fig 2). While the diagnostic features severity of the radiographic lesion does not necessarily appear Septic osteitis (O; infection of bones lacking a medullary to affect long-term outcome (Steel et al. 1999; Kay et al. 2012), cavity) and osteomyelitis (OM) are common in foals up to age its location is more likely to determine future soundness. approximately 4 months and often involve adjacent synovial Successful elimination of infection manifests radiographically structures (Firth 1983; Neil et al. 2010). The source of bacteria, as sharp delineation of the original defect and surrounding their species and the physiological and anatomical sclerosis (Fig 3). This being said, it can take many months for a considerations that favour their growth at sites of predilection defect to regain mineral density, if at all (Lawrence and Fraser are summarised by Lawrence and Fraser (2013) and elsewhere 2013). Therefore, a positive clinical progression (decreased in the literature (Firth 1983; Brewer and Koterba 1990; Schneider swelling and lameness) and improved results of repeated et al. 1992; Vatistas et al. 1993; Hardy 2006; Neil et al. 2010). clinicopathological testing represent more important In mature horses, O/OM are usually associated with indicators of early success in treatment. penetrating injuries or previous surgical interventions. In the report by Lawrence and Fraser (2013), 2 weanlings, aged 5 and Current treatment strategies in man and equids 6 months, were affected by septic osteitis of the proximal In their ‘plea for general conservatism in the treatment of sesamoid bones (PSB). In horses of this age haematogenous septic osteomyelitis of the skull and face’ Blair and Brown seeding of bacteria remains the most likely initiating cause in (1927) remind human practitioners of an old Italian proverb the absence of external injury, although a primary septic focus that states ‘He who goes slowly goes safely; he who goes elsewhere in the body is rarely identified (Wisner et al. 1991; safely goes surely’. Unfortunately the question as to just Dabareiner et al. 2001; Witte and Rodgerson 2005; Sherman how ‘safe’ or ‘sure’ a conservative approach is, remains et al. 2006). It is assumed that the relatively convoluted blood unanswered in both human and equine medicine. supply to the axial borders of the PSB and the intersesamoidean Current treatment recommendations in the equine ligament makes them predilection sites for haematogenous veterinary literature include surgical debridement of bone as septic osteitis and desmitis in weanlings and mature equids a primary course of action to address O/OM (Goodrich and (Wisner et al. 1991; Dabareiner et al. 2001; Barr et al. 2005; Nixon 2004; Schneider 2006; McIlwraith 2007). In contrast, Sherman et al. 2006; Lawrence and Fraser 2013). treatment of the human equivalent (acute haematogenous Lameness, focal pain and swelling (oedema and effusion) osteomyelitis [AHO] in paediatric patients) appears to focus dominate the clinical picture of O/OM (Bramlage 1998). In on prolonged systemic antimicrobial therapy (Le Saux et al. cases with effusion, synovial fluid analysis as well as culture and 2002; Peltola et al. 2010). A recent prospective, randomised sensitivity testing provide valuable information (Bramlage 1998; trial investigating appropriate antimicrobial treatment Sayegh et al. 2001). With the exception of an elevated body regimens found that extensive surgical interventions are rarely temperature, there is often a paucity of signs indicating a necessary in children (Peltola et al. 2010). The exception to systemic response (Goodrich and Nixon 2004). Plasma this is the presence of an obvious abscess, from which © 2012 EVJ Ltd 68 EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2013 Fig 1: Dorsolateral-palmaromedial oblique radiograph of the right front fetlock and corresponding trans-sectional CT image at the indicated level (dotted line) of an 11-month-old Welsh Pony. The pony presented with a nonweightbearing lameness of this limb of 3 weeks’ duration. Effusion of both the digital sheath and metacarpophlangeal joint was present. The medial PSB had a large septic bone lesion, identified with conventional radiographs (arrowheads). Proximal to this, a pathological fracture of the medial PSB had occurred (arrow) as seen on CT imaging. Fig 2: Dorsopalmar radiograph of a right front fetlock and corresponding MR image at the indicated level (dotted line) of a 12-year-old Camargue Pony presented with chronic, intermittent moderate right forelimb lameness. Lameness was abolished with intrathecal anaesthesia of the digital sheath, after which the horse showed a mild left forelimb lameness. Chronic, aseptic lytic lesions affecting the axial border of the medial PSB (arrowheads and white arrow) were present in both front limbs. purulent material is aspirated (Blyth et al. 2001; De Boeck to have inoperable lesions due to extensive physeal 2005; Goergens et al. 2005). The continued emergence of involvement or surgically inaccessible locations such as the multiresistant pathogens such as community-acquired ilium or navicular bone. A conservative approach was methicillin-resistant Staphylococcus aureus in human patients therefore elected due to the morbidity likely to result from has resulted in an increased necessity for surgical intervention surgical intervention. Rather surprisingly, therefore, 7 of these 9 (Darville and Jacobs 2004; Harik and Smeltzer 2010). Surgical foals (78%), compared with 80 of the remaining 98 foals (82%) exploration and debridement are also indicated if a patient were reported to have a successful outcome (one foal was does not respond to empiric antibiotic therapy within an subjected to euthanasia without pursuing treatment). appropriate time frame by showing persisting signs of pain Another recent report focused on the treatment of septic and fever (Stanitski 2004; Goergens et al. 2005; Harik and osteomyelitis of the patella (Kay et al. 2012). There, 6 of 8 foals Smeltzer 2010). (75%) made a full recovery. Notably, all surviving foals were Closer analysis of the data presented in reports of O/OM treated without surgical debridement of the patellar lesion, but cases in the veterinary literature (Witte and Rodgerson 2005; all received intralesional antimicrobials. Although numbers are Neil et al. 2010; Kay et al. 2012; Lawrence and Fraser 2013) small, these reports suggest that cases treated without bone allows us to consider the value of an initial conservative debridement can have an equally successful outcome when approach in the equine case with lytic bone lesions. In a compared to previous studies (Schneider et al. 1992; Vatistas retrospective study of 108 foals, medical therapy alone et al. 1993; Axon et al. 1999). Figures 3–5 are further examples was pursued in 9 (Neil et al. 2010), which were considered of cases treated successfully with antimicrobial therapy alone. © 2012 EVJ Ltd EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2013 69 a) b) Fig 3: Initial (a) and one month follow-up (b) lateromedial radiographic projections of the left stifle of a 4-week-old Thoroughbred foal affected with O/OM of the distal femoral physis. Note the location of the patella (due to severe femoropatellar joint effusion) and extensive lytic lesions (arrows) upon initial presentation and the sclerotic demarcation (arrowheads) after successful treatment without surgical debridement. a) b) Fig 4: Caudocranial radiographic projections of the left stifle of a one-month-old Warmblood colt presented for an
Load more

Recommended publications
  • Hyperostosis Corticalis Infantalis (Caffey's Disease)* J
    754 S.A. TYDSKRIF VIR GENEESKU DE 14 Junie 1969 HYPEROSTOSIS CORTICALIS INFANTALIS (CAFFEY'S DISEASE)* J. M. WAGNER, M.B., B.CH., M.R.e.p., Senior Paediatrician, Edenvale Hospital, AND A. SoLOMON, M.B., B.CH., DIP.MED., D.M.R.(D.), Radiologist, Pneumoconiosis Research Unit, CSIR, Baragwanath Hospital, Johannesburg Infantile cortical hyperostosis is a disorder affecting the skeleton and some of its contiguous fascias and muscles. It is suggested that infantile cortical hyperostosis is a pre­ natal collagen disease.' The early stage is of acute inflammation and loss of the periosteal and subperiosteal definition. There is a fibrous and osteoblastic reaction and overlying tissue including muscle is involved. No bacteria are seen. Later, there is subperiosteal new lamellar bone formation. The peri­ osteum is thickened and hyperplastic and the overlying soft tissues are oedematous and sections show round-cell infiltration. The subacute phase re-establishes periosteum as an entity. The later remodelling stage removes the extraperipheral bone from within, resulting in dilatation of the medullary cavity. There is evidence to suggest that infantile cortical hyper­ ostosis had been recognized in 1930.' Caffey and Silver­ man first described the disease in 1946." Smyth et al.' also recorded cases in 1946. Altogether 102 cases have been reported, Sidbury and Sidbury' contributing 69 reports and Holrnan' describing 33 cases. Infantile cortical hyper­ ostosis has been described in Negroes but seems rare in the South African Bantu. CASE REPORT The patient, a 3-year-old Bantu male, had a normal birth­ weight. Two siblings were in good health. The mother stated that the child's jaw was swollen and that he had Fig.
    [Show full text]
  • Chronic Non-Bacterial Osteomyelitis/Osteitis (Or CRMO) Version of 2016
    https://www.printo.it/pediatric-rheumatology/IE/intro Chronic non-Bacterial Osteomyelitis/Osteitis (or CRMO) Version of 2016 1. WHAT IS CRMO 1.1 What is it? Chronic Recurrent Multifocal Osteomyelitis (CRMO) is the most severe form of Chronic Non-bacterial Osteomyelitis (CNO). In children and adolescents, the inflammatory lesions predominantly affect the metaphyses of the long bones of the lower limbs. However, lesions can occur at any site of the skeleton. Furthermore, other organs such as the skin, eyes, gastrointestinal tract and joints can be affected. 1.2 How common is it? The frequency of this disease has not been studied in detail. Based on data from European national registries, approximately 1-5 of 10,000 inhabitants might be affected. There is no gender predominance. 1.3 What are the causes of the disease? The causes are unknown. It is hypothesised that this disease is linked to a disturbance in the innate immune system. Rare diseases of bone metabolism might mimic CNO, such as hypophosphatasia, Camurati- Engelman syndrome, benign hyperostosis-pachydermoperiostosis and histiocytosis. 1.4 Is it inherited? 1 / 6 Inheritance has not been proven but is hypothesized. In fact, only a minority of cases is familial. 1.5 Why does my child have this disease? Can it be prevented? The causes are unknown to date. Preventive measures are unknown. 1.6 Is it contagious or infectious? No, it is not. In recent analyses, no causative infectious agent (such as bacteria) has been found. 1.7 What are the main symptoms? Patients usually complain of bone or joint pain; therefore, the differential diagnosis includes juvenile idiopathic arthritis and bacterial osteomyelitis.
    [Show full text]
  • Tuberculosis of the Pubic Symphysis Masquerading As Osteitis Pubis: a Case Report
    CASE REPORT Acta Orthop Traumatol Turc 2012;46(3):223-227 doi:10.3944/AOTT.2012.2696 Tuberculosis of the pubic symphysis masquerading as osteitis pubis: a case report Shailendra SINGH, Sumit ARORA, Sumit SURAL, Anil DHAL Department of Orthopedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India Tuberculosis is one of the oldest diseases affecting mankind and is known for its ability to present in various forms and guises. Pubic symphysis is an uncommon site for tuberculous affliction; hence very few cases have been reported in the English-language literature. We present a rare case of pubic sym- physis tuberculosis diagnosed as osteitis pubis before presentation to our institution. The patient made an uneventful recovery following antitubercular chemotherapy. Key words: Antitubercular chemotherapy; osteitis pubis; pubic symphysis; tuberculosis. Tuberculosis has been recorded in Egyptian mummies Case report aging back to 3000 B.C. It commonly affects the pul- A 35-year-old male presented with a history of supra- monary system but extrapulmonary involvement is pubic pain for six months following a fall while playing seen in approximately 14% of patients, with 1% to 8 % football. The pain was insidious in onset, dull aching in [1] having osseous involvement. The major areas of nature and localized in the suprapubic area. It predilection in order of occurrence are: spine, hip, increased on exertion and relieved with rest and anti- knee, foot, elbow and hand. Tuberculosis of the pubic inflammatory medications and was not aggravated by symphysis is rare and few cases have been presented in coughing, sneezing, voiding or straining during stool.
    [Show full text]
  • Infantile Peri-Osteitis Postgrad Med J: First Published As 10.1136/Pgmj.74.871.307 on 1 May 1998
    Self-assessment questions 307 Infantile peri-osteitis Postgrad Med J: first published as 10.1136/pgmj.74.871.307 on 1 May 1998. Downloaded from Alaric Aroojis, Harold D'Souza, M G Yagnik A 14-week-old girl was brought in with a history of painful swelling of both legs since the age of one month. The onset was insidious and was not associated with trauma or fall. There was no his- tory of fever or associated constitutional symp- toms. The birth history was normal and the infant was apparently asymptomatic until the age of one month. Examination revealed a healthy and alert infant. Both legs were bowed anteriorly and a uniform bony thickening of both tibiae was palpable throughout their lengths (figure 1). Both legs were extremely ten- der and the infant would withdraw both lower limbs and cry incessantly if any attempt was made to touch them. There was no increase in local temperature nor redness of the overlying skin. Knees and ankle joints were normal and demonstrated a full range of motion. Regional lymph nodes were not enlarged and other bones and joints were normal on examination. X-Rays of both legs revealed peri-osteitis of both tibiae with extensive subperiosteal new bone forma- tion involving the entire diaphysis (figure 2). Questions 1 What is the differential diagnosis of peri- osteitis in an infant? 2 What further investigations are required? Figure 1 Clinical photograph showing bony swelling 3 What is the likely diagnosis and treatment? with anterior bowing of both legs http://pmj.bmj.com/ on October 5, 2021 by guest.
    [Show full text]
  • A Rare Manifestation of Primary Hyperparathyroidism Vikram Singh Shekhawat, Anil Bhansali
    Images in… BMJ Case Reports: first published as 10.1136/bcr-2017-220676 on 1 August 2017. Downloaded from Vanishing metatarsal: a rare manifestation of primary hyperparathyroidism Vikram Singh Shekhawat, Anil Bhansali Department of Endocrinology, DESCRIPTION Post Graduate Institute A 31-year-old woman presented with a history of Medical Education and of bone pains, difficulty in walking and painless Research, Chandigarh, India swelling of the left foot for the last 1 year (figure 1). X-ray of the left foot showed multiple lytic lesions Correspondence to Dr Anil Bhansali, in metatarsal bones and the absence of proximal anilbhansa lien docr ine@ gma il. half of shaft of second metatarsal. Biochemistry com, ashuendo@ gmail. com results revealed corrected serum calcium 11.2 mg/ dL, phosphate 2.0 mg/dL, alkaline phosphatase Accepted 25 July 2017 1049 IU/mL, intact parathyroid hormone (iPTH) 2543 pg/mL, 25-hydroxyvitamin D 16.2 ng/mL, and serum creatinine 0.6 mg/dL. She had no history of pancreatitis or evidence of renal/gall stone disease. The skeletal survey showed multiple osteitis fibrosa cystica (OFC) lesions, pathological Figure 2 (A) X–ray of both foot showing generalised fracture of shaft of the left femur and salt and demineralization of foot bones, multiple lytic lesions pepper appearance of the skull (figure 2a, b, c). (brown tumours) and apparent disappearance of proximal Sestamibi scan revealed right inferior parathyroid half of second metatarsal of the left foot. (B) X–ray of adenoma measuring 3.0×2.9×2.2 cm. Based on pelvis showing ill-defined lucencies in bilateral iliac, pubic the above findings, a diagnosis of primary hyper- and ischial bones, and pathological fracture of left femur.
    [Show full text]
  • Clinical and Laboratory Considerations in Metabolic Bone Disease
    ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 5, No. 4 Copyright ® 1975, Institute for Clinical Science Clinical and Laboratory Considerations in Metabolic Bone Disease LYNWOOD H. SMITH, M.D. AND B. LAWRENCE RIGGS, M.D. Mayo Clinic and Mfiyo Foundation Rochester, MN 55901 ABSTRACT An overview of the common types of metabolic bone disease is described. When the disease is present in pure form, diagnosis is not difficult. When mixed disease is present, as may be the case, the pathophysiology involved must be clearly under­ stood for accurate diagnosis and treatment. Introduction opausal or senile osteoporosis, a disorder of unknown etiology, is the commonest form of There are many metabolic disorders that bone disease in the Western hemisphere. affect human bones; but, fortunately, the This disorder may simply represent an exag­ ways in which bones can respond are limited geration of the normal loss of bone that oc­ so that certain generalizations are valid for a curs with aging. It is estimated that the total group of diseases causing a characteristic bone loss between youth and old age is metabolic abnormality in the bone. The about 35 percent in women and somewhat common pathologic responses to metabolic less in men. The loss of bone that has oc­ bone disease include osteoporosis, os­ curred in some patients with osteoporosis is teomalacia, Paget’s disease, osteitis fibrosa not significantly different from that in age- cystica and renal osteodystrophy. These are matched normals without osteoporosis. not mutually exclusive, and it is not uncom­ In osteoporosis there is a greater propor­ mon to find more than one abnormality in tional loss of trabecular than of cortical the same patient.
    [Show full text]
  • Zoledronic Acid
    Zoledronic acid (Zometa®, Reclast®) (Intravenous) Document Number: IC‐0153 Last Review Date: 07/03/2019 Date of Origin: 06/21/2011 Dates Reviewed: 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 05/2015, 08/2015, 11/2015, 02/2016, 05/2016, 08/2016, 11/2016, 01/2017, 05/2017, 08/2017, 07/2018, 07/2019 I. Length of Authorization Zometa: Coverage is provided for 12 months and may be renewed. Reclast: Prevention of osteoporosis in post-menopausal women: Coverage is provided for 24 months and may be renewed. All other indications: Coverage is provided for 12 months and may be renewed (unless otherwise specified). II. Dosing Limits A. Quantity Limit (max daily dose) [Pharmacy Benefit]: Zometa Indication Quantity Limit Hypercalcemia of malignancy 4 mg bottle/vial per 7 days Multiple myeloma & bone metastases from 4 mg bottle/vial every 21 days solid tumors Prevention of bone loss in breast cancer 4 mg bottle/vial every 168 days (6 months) Prevention of bone loss in prostate cancer & 4 mg bottle/vial every 84 days (3 months) Prevention or treatment of osteoporosis in prostate cancer Reclast Indication Quantity Limit Proprietary & Confidential © 2019 Magellan Health, Inc. Prevention of osteoporosis in post- 5 mg solution every 730 days (24 months) menopausal women All other indications 5 mg solution every 365 days (12 months) B. Max Units (per dose and over time) [Medical Benefit]: Zometa Indication Max Units Hypercalcemia of malignancy 4 billable units per 7 days Multiple myeloma & bone metastases from 4 billable units every 21 days solid tumors Prevention of bone loss in breast cancer 4 billable units every 168 days (6 months) Prevention of bone loss in prostate cancer & 4 billable units every 84 days (3 months) Prevention or treatment of osteoporosis in prostate cancer Reclast Indication Max Units Prevention of osteoporosis in post- 5 billable units every 730 days (24 months) menopausal women All other indications 5 billable units every 365 days (12 months) III.
    [Show full text]
  • Freiberg's Infraction, Compression Fractures and Osteochondritis
    FREIBERG'S INFRACTION, COMPRESSION FRACTURES AND OSTEOCHONDRITIS Thomas Smith, D.P.M. George R. Vito, D.P.M. INTRODUCTION They theorized that necrosis was caused by the absence or loss of vascular connections to the subchondral bone Freiberg's infraction is the fourth most common beneath the cartilage. They commented on the preferen- avascular necrosis affecting an articular surface. lt usually tial location of the infraction on the dorsal part of the affects the second metatarsal, but may occur in any of second metatarsal head but could not explain how the the lesser metatarsals (1). The onset of the disease is fatigue fracture occurred in this location (6). Wiley and usually after the age of 13 with a normal range between Thurston (7) in 1981, on the basis of an injection study, 12 and 18 years of age (2). Subclinical manifestations found that in two of six cadavers the second metatarsal usually occur during adolescence. Symptoms may not arteries supplying the epiphysis were absent. The second appear until degenerative changes occur within the joint ray is supplied by branches from the first and third rays. in adulthood. A predilection for females exists with a Stress studies revealed that the second metatarsal bore ratio of 3 to 1 (3). more load than the third or fourth metatarsals (B). The metatarsal bones are each ossified from two Currently the etiology of Freiberg's infraction is at- centers; one for the body and one for the head of the tributed to interruption of a precarious blood supply to second, third, fourth, and fifth metatarsals.
    [Show full text]
  • Hyperostosis-Osteitis (SAPHO) Syndrome Presenting with Osteomyelitis of the Clavicle Chetan Sharma, MD; Brian Chow, MD
    CASE REPORT A Case of Atypical Synovitis-Acne-Pustulosis- Hyperostosis-Osteitis (SAPHO) Syndrome Presenting With Osteomyelitis of the Clavicle Chetan Sharma, MD; Brian Chow, MD ABSTRACT the time of injury indicated a fracture in Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is considered after exclusion the medial left clavicle. Three months later, of infection and arthritis; however, microbial infection may be present in osteoarticular lesions of she presented at pediatrician’s office due to these patients. Chronic osteomyelitis and associated bacterial infection were detected in a recur- worsening pain, and follow-up radiogra- rent osteoarticular lesion in an adolescent patient with a history of clavicle pain, who complained phy revealed marked homogeneous corti- of recurrent swelling in the left clavicle. Most pediatric case reports of SAPHO syndrome describe cal thickening of the proximal two-thirds patients with associated skin conditions. This case report describes a patient diagnosed with of the clavicle. Laboratory evaluation was SAPHO syndrome with no associated skin condition. Although SAPHO syndrome is characterized unremarkable except for elevation in eryth- by dermatological and osteological symptoms, this acronym describes a collection of recurring rocyte sedimentation rate (ESR) at 34 mm/ symptoms. Complete patient medical history and thorough testing, including radiology and hr (reference range 0-14 mm/hr). Magnetic biopsy, are critical for prompt diagnosis and treatment of this condition, particularly
    [Show full text]
  • Garre's Osteomyelitis: a Case Report
    PEDIATRICDENTISTRY/Copyright ~ 1981 by The American Academyof Pedodontics/Vol. 3, No. 3 Garre’s osteomyelitis:a case report Stephane Schwartz, DDS, MS Huan Pham, DOS, MS Abstract Palpation revealed a usually smooth, bone-hard le- Onecase of Garre’sosteomyelitis in volving the mandible sion which felt like an inherent part of the mandible. was seen, treated and documented.It was treated by extraction of the causal infected tooth with no supplement The size of the bone lesion could vary from a few cen- of antibiotics. The patient experienceda completeregression timeters to the whole length of the mandible, and of the lesion with six months. could expand as much as 2 cm laterally. All cases caused a noticeable asymmetryof the face. Introduction Unlike other forms of osteomyelitis, there is no Garre’s osteomyelitis was first described by Carl marked increase in fever, white blood cell count, sedi- Gaffe in 1893 as "a focal gross thickening of perios- mentation rate or alkaline phosphatase values. teum with peripheral reactive bone formation result- Radiographic Findings ing from infection, m It was reported only in long Panoramic and occlusal views would typically show bones, particularly in the tibia, until 1948 when a localized overgrowth of bone on the outer surface of Berger described a case involving the mandible. 2 In the cortex. This mass of bone, which is supracortical 1973, Batcheldor et al. 3 claimed that only six reports but subperiosteal, is smooth, fairly calcified, and is of proliferative osteomyelitis of the jaw had been often described as a duplication of the cortical layer of reported, and added two cases of their own.
    [Show full text]
  • Clinical and Radiographic Features of Chronic Monostotic Fibrous Dysplasia of the Mandible
    C LINICAL P RACTICE Clinical and Radiographic Features of Chronic Monostotic Fibrous Dysplasia of the Mandible • Steven R. Singer, DDS • • Muralidhar Mupparapu, DMD, MDS • • Joseph Rinaggio, DDS, MS • Abstract Chronic untreated fibrous dysplasia of the mandible in a 40-year-old man is described, with emphasis on the radiographic findings. To the authors’ knowledge, this is the first such case to be reported in the literature. Within this mature mandibular lesion, a large radiolucency was noticed, with the appearance of a simple bone cyst. The patient did not have any symptoms directly related to the mandibular lesion. Various aspects of the diagnosis, radiographic appearance and differential diagnosis are discussed. The information presented here will be useful for all dentists, oral and maxillofacial surgeons, physicians and other health care providers in identifying the appearance of chronic fibro-osseous lesions. MeSH Key Words: diagnosis, differential; fibrous dysplasia of bone; mandibular diseases/diagnosis © J Can Dent Assoc 2004; 70(8):548–52 This article has been peer reviewed. ibrous dysplasia is a disturbance of bone metabolism views (Fig. 2), and these radiographs were available to the that is classified as a benign fibro-osseous lesion. radiology clinic through the hospital’s Web-based Picture F Fibrous connective tissue containing abnormal bone Archiving and Communication System. replaces normal bone. The etiology of fibrous dysplasia is However, the existence of the skull films was not known unknown. The radiographic appearance of the irregularly at the time of the patient’s presentation to the radiology shaped trabeculae aids in the differential diagnosis. clinic, and the requested panoramic radiograph was obtained Occurring most commonly in the second decade of life, the (Fig.
    [Show full text]
  • Osteoporosis in Patients with Chronic Kidney Diseases: a Systemic Review
    International Journal of Molecular Sciences Review Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review 1,2, 3,4, 5,6, Chia-Yu Hsu y , Li-Ru Chen y and Kuo-Hu Chen * 1 Department of Rehabilitation Medicine, Ten-Chan General Hospital, Zhongli, Taoyuan 320, Taiwan; [email protected] 2 Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan 3 Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan; [email protected] 4 Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu 300, Taiwan 5 Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan 6 Department of Medicine, School of Medicine, Tzu-Chi University, Hualien 970, Taiwan * Correspondence: [email protected]; Tel.: +886-2662-89779 These authors contributed equally to this work. y Received: 15 August 2020; Accepted: 16 September 2020; Published: 18 September 2020 Abstract: Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification.
    [Show full text]