Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Treatment of life-threatening acute osteomyelitis of the jaw during chemotherapy: a case report

  • Jung, Junhong (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital) ;
  • Kim, Sumin (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital) ;
  • Park, Jun-Sang (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital) ;
  • Lee, Choi-Ryang (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital) ;
  • Jeon, Jae-ho (Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Seoul National University) ;
  • Kwon, Ik-Jae (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital)
  • Received : 2020.07.15
  • Accepted : 2020.08.17
  • Published : 2020.08.31
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Abstract

Oral and maxillofacial infection is a common complication in patients undergoing chemotherapy. The treatment of oral diseases in such patients differs from that administered to healthy patients. This paper reports a case of acute osteomyelitis of odontogenic origin following a recent chemotherapy session. The patient's condition was life-threatening because of neutropenic fever and sepsis that developed during the inpatient supportive care. However, the patient showed prompt recovery within 40 days following the use of appropriate antibiotics and routine dressing, without the requirement for surgical treatment, except tooth extraction. As seen in this case, patients undergoing chemotherapy are more susceptible to rapid progression of infections in the oral and maxillofacial areas. Therefore, accurate diagnosis through prompt clinical and radiological examination, identification of the extent of infection, and assessment of the patient's immune system are crucial for favorable outcomes. It is also necessary to eliminate the source of infection through appropriate administration of antibiotics. In particular, a broad-spectrum antibiotic with anti-pneumococcal activity is essential. Proper antibiotic administration and wound dressing are essential for infection control. Furthermore, close consultation with a hemato-oncologist is necessary for effective infection management based on the professional evaluation of patients' immune mechanisms.

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References

  1. Raber-Durlacher JE, Barasch A, Peterson DE, Lalla RV, Schubert MM, Fibbe WE. Oral complications and management considerations in patients treated with high-dose chemotherapy. Support Cancer Ther 2004; 1: 219-29. https://doi.org/10.3816/SCT.2004.n.014
  2. Sonis ST. Mucosal injury in cancer patients: New strategies for research and treatment: proceedings of a multidisciplinary conference held in Bethesda. Maryland, National Cancer Institute. 2000.
  3. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res 1994; 8: 263-71. https://doi.org/10.1177/08959374940080022001
  4. Crawford J, Dale DC, Kuderer NM, Culakova E, Poniewierski MS, Wolff D, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw 2008; 6: 109-18. https://doi.org/10.6004/jnccn.2008.0012
  5. Peterson DE, Sonis ST. Oral complications of cancer chemotherapy: Springer Science & Business Media, 2012.
  6. Baden LR, Swaminathan S, Almyroudis NG, Angarone M, Blouin G, Camins BC, et al. Prevention and treatment of cancer-related infections-version 1. 2020., J Natl Compr Canc Netw, 2019.
  7. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. Lancet Oncol 2003; 4: 595-604. https://doi.org/10.1016/S1470-2045(03)01218-X
  8. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730-51. https://doi.org/10.1086/339215
  9. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258-66. https://doi.org/10.1002/cncr.21847
  10. Becker PS, Griffiths EA, Alwan LM, Bachiashvili K, Brown A, Cool R, et al. NCCN Guidelines Insights: Hematopoietic Growth Factors, Version 1.2020: J Natl Compr Canc Netw 2020; 18: 12-22. https://doi.org/10.6004/jnccn.2020.0002
  11. Kostler WJ, Hejna M, Wenzel C, Zielinski CC. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA Cancer J Clin 2001; 51: 290-315. https://doi.org/10.3322/canjclin.51.5.290
  12. Chow AW. Infections of the oral cavity, neck, and head. In: Principles and practice of infectious diseases. 7th ed. Edited by Gerald L. Mandell, John E. Bennett, Raphael Dolin. United States. 2010, pp 855-71.
  13. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medicationrelated osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg 2014; 72: 1938-56. https://doi.org/10.1016/j.joms.2014.04.031
  14. Baltensperger MM, Eyrich GK. Textbook on Osteomyelitis of the Jaws. Leipzig, Springer-Verlag Berlin Heidelberg. 2009.
  15. Marx RE. Chronic osteomyelitis of the jaws. Oral Maxillofac Surg Clin North Am 1991; 3: 367-81. https://doi.org/10.1016/S1042-3699(20)30505-7
  16. Toljanic JA, Bedard JF, Larson RA, Fox JP. A prospective pilot study to evaluate a new dental assessment and treatment paradigm for patients scheduled to undergo intensive chemotherapy for cancer. Cancer 1999; 85: 1843-8. https://doi.org/10.1002/(SICI)1097-0142(19990415)85:8<1843::AID-CNCR26>3.0.CO;2-R