Browse > Article

THE LONG-TERM CONSERVATIVE DRAINAGE CARE OF EXTENSIVE OSTEOMYELITIS ASSOCIATED WITH MANDIBULAR COMPOUND FRACTURE : REPORT OF A CASE  

Kim, Ha-Rang (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Yoo, Jae-Ha (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Choi, Byung-Ho (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Sul, Sung-Han (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Mo, Dong-Yub (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Lee, Chun-Ui (Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University (Wonju Christian Hospital))
Publication Information
Maxillofacial Plastic and Reconstructive Surgery / v.31, no.6, 2009 , pp. 544-549 More about this Journal
Abstract
Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.
Keywords
Fracture osteomyelitis; Post-operative infected wound; Long-term conservative drainage;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Kaban LB, Pogrel MA, Perrott DH : Complications in oral and maxillofacial surgery. WB Saunders, 1997, p121
2 Kim J, Yoo JH, Yoon JH et al : Clinical guide in dental management of the medically compromised patients. Kunja Publishing Co, 2005, p11
3 Park TW, Lee SR, Kim JD et al : Oral and maxillofacial radiology. Narae Publishing Co, 2001, p516
4 Koury M, Ellis E : Rigid internal fixation of infected mandibular fractures . Journal of Oral and Maxillofacial Surgery 50 : 434, 1993   DOI
5 Koury ME, Perrott DH, Kaban LB : The use of rigid internal fixation in mandibular fractures complicated by osteomyelitis. Journal of Oral and Maxillofacial Surgery 52 : 1114, 1994   DOI   ScienceOn
6 Sabiston DC : Textbook of surgery, Vol 1. 13th ed. WB Saunders, 1986, p23
7 Iizuka T, Lindqvist C, Hallihainen D et al : Infection after rigid internal fixation of mandibular fractures : A clinical and radiographic study. Journal of Oral and Maxillofacial Surgery 49 : 585, 1991   DOI   ScienceOn
8 William JL : Rowe and Williams' maxillofacial injuries, Vol II. Second ed. Churchill Livingstone, 1994, p845
9 Stone I, Dodson TB, Bays RA : Risk factors for infection following operative treatment of mandibular fractures. Plastic Reconstructive Surgery 91 : 64, 1993   DOI   ScienceOn
10 Conley JJ : Complications of head and neck surgery. WB Saunders, 1979, p358
11 Roitt IM, Lehner T : Immunology of oral disease, Second edition. Blackwell Scientific Publications, 1983, p279
12 Fonseca RJ and Walker RV : Oral and maxillofacial trauma, Vol II. WB Saunders, 1991, p1150
13 Topazian RG, Goldberg MH : Management of infections of the oral and maxillofacial regions. WB Saunders, 329, 1981, p247
14 Kim JB, Yoo JH, Choi BH : Conservative care of nonunion owing to osteomyelitis associated with fracture of mandible, report of 3 cases. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 23(5) : 471, 2001
15 Prein J, Beyer M : Management of infection and nonunion in mandibular fractures. Oral and Maxillofacial Clinics of North America 2 : 187, 1990
16 Peacock EE, Winkle WV : Wound repair, Second ed. WB Saunders, 1976, p624
17 Yoo JH, Lee JW : The care of infected orocutaneous open wounds after open reduction in compound comminuted fracture of mandible, report of cases. The Journal of Korean Association of Maxillofacial Plastic and Reconstructive Surgeons 11 : 267, 1989
18 Schultz RC : Facial injuries, Second ed. Year Book Medical Publishers, 1988, p450
19 Kruger GO : Textbook of oral and maxillofacial surgery, Sixth ed. CV Mosby, p333-356, 1984
20 Dingman RO, Natvig P : Surgery of facial fractures. WB Saunders, 1984, p339
21 Kim GS, Lee DK : Oral and maxillofacial infections. Kunja Publishing Co, 1992, p171
22 Kruger E, Schilli W : Oral and maxillofacial traumatology, Vol I. Quintessence book, 1982, p134