ACUTE OSTEOMYELITIS OF THE MANDIBLE IN A GERIATRIC FEMALE INDIVIDUAL DURING PANDEMIC IN INDIA: A CASE REPORT AND LITERATURE REVIEW

Abstract

A 75-year-old female patient reported to our hospital with pain and swelling on the left side of the face. Patient experienced severe throbbing pain a few days after extraction. Swelling developed 2 weeks after the extraction and progressively increased in size. Past dental history revealed that she had undergone extraction of lower left second molar 1 month back. Past medical history revealed that she was diabetic and hypertensive and was under medication for the same for the past 21 years. Patient had no history of jaw fracture and radiation exposure. Radiograph features showed cortical destruction and an increase in CRP level was observed through lab investigations. Radiograph revealed radiolucency with cortical bone destruction in relation to the lower left mandibular region. Laboratory investigations revealed an elevated CRP level and an increased albumin level in urine. Based on the history, clinical features, radiographic features and laboratory diagnosis a diagnosis of acute osteomyelitis was given. Incision and drainage were done followed by antibiotic therapy. The exposed bone was removed followed by curettage and irrigation. Patient was recalled after 10 days and exhibited no post-operative complications. This case was treated with antibiotic therapy and localized surgical management. The primary goal is treatment and or elimination of the causative factor followed by antibiotic therapy instituted according to antibiogram. Surgical therapy includes incision and drainage, jaw resection in invasive and extensive cases. Decortication, sequestrectomy and saucerization can also be done. Hyperbaric oxygen therapy can be given in patients with chronic osteomyelitis associated with necrotizing soft tissue. Improved patient survival, better outcome and a decreased need for surgical intervention have been observed in patients treated with hyperbaric oxygen. Osteomyelitis is a rare, invasive and destructive bacterial infection that can affect the quality of life. Further research in diagnosis criteria and techniques for management of osteomyelitis must be developed for better outcome and patient survival.