scholarly journals Osteomielite crônica mandibular em pacientes pediátricos

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Matheus Francisco Barros Rodrigues ◽  
Layla Louise de Amorim Rocha ◽  
Cristofe Coelho Lopes da Rocha ◽  
Sérgio Takashi Kussaba
Keyword(s):  
Rio De Janeiro ◽  
Chronic Osteomyelitis ◽  
Multimodality Imaging ◽  
Cruciate Ligament ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Multifocal Osteomyelitis ◽  
Diagnosis And Classification ◽  
Anterior Cruciate ◽  
Meniscus Cells

A osteomielite é considerada uma doença incomum em pacientes saudáveis e de difícil diagnóstico e tratamento. Estudos sugerem que patologias infecciosas periodontais e peri-implantares como gengivites, periodontites e peri-implantites atuam como fatores mais comuns, predisponentes para osteomielites dos maxilares. Osteomielites crônicas exigem tratamento com cobertura antibiótica e procedimentos cirúrgicos. O tratamento envolve avaliação, determinação da etiologia, terapia antimicrobiana, desbridamento da lesão, remoção dos sequestros ósseos e decorticação óssea associada ao emprego sistêmico de antimicrobianos, geralmente de amplo espectro. O presente trabalho tem como objetivo relatar dois casos clínicos de osteomielite crônica infantil, bem como realizar uma análise comparativa de casos clínicos já publicados em artigos científicos. Pôde-se concluir que a associação de características clínicas, exames histopatológicos e achados radiográficos podem reunir características comuns para diversos tipos de osteomielite. Portanto, devem culminar em fatores contribuintes para o diagnóstico final. Em ambos os casos relatados, o tratamento foi eficaz utilizando terapia medicamentosa com o uso de anti-inflamatórios e antibióticos aliados a tratamento cirúrgico que consistiu em desbridamento da lesão. Ambos os pacientes foram acompanhados e proservados, não havendo recidiva. Descritores: Osteomielite; Antibacterianos; Patologia Bucal; Procedimentos Cirúrgicos Bucais.ReferênciasHupp JR, Ellis E, Tucker MR. Cirurgia oral e maxilofacial contemporânea. Rio de Janeiro: Elsevier; 2011.Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364(9431):369-79.Baltieri BR, Gabrielli MAC, Gabrielli MFR, Pereira Filho VA, Lopes FS, Leite VA. Osteomielite em mandíbula de criança. Rev Odontol Unesp. 2014;43(N Especial):262.Gaetti Júnior E, Gaetti Jardim EC, Faverani LP, Landucci KC, Landucci LF. Osteomielite crônica dos maxilares: aspectos clínicos, terapêuticos e microbiológicos. Salusvita. 2008;27(1):125-39.Carek PJ, Dickerson LM, Sack JL . Diagnosis and management of osteomyelitis. Am Fam Physician. 2001;63(12):2413-20.6.     Miloro M, Ghali GE, Larse PE, Waite PD. Princípios de cirurgia bucomaxilofacial de Peterson. 2ed. São Paulo: Santos; 2008.Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. Rio de Janeiro: Elsevier; 2011.Watanabe T, Ono H, Morimoto Y, Otsuki Y, Shirai M, Endoh A et al. Skull involvement in a pediatric case of chronic recurrent multifocal osteomyelitis. Nagoya J Med Sci. 2015;77(3):493-500.Suei Y, Taguchi A, Tanimoto K. Diagnosis and classification of mandibular osteomyelitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):207-14.Masocatto DC, Oliveira MM, Mendonça JCG. Osteomielite crônica mandibular: relato de caso. Arch Health Invest.2017;6(2):48-52Ferraria N, Marques JG, Ramos F, Lopes G, Fonseca JG, Neves MC. Osteomielite crónica multifocal recorrente: série de 4 casos clínicos tratados com bifosfonatos. Acta Reumatol Port. 2014;39(1):38-45Paim LB, Liphaus BL, Rocha AC, Castellanos LZA, Silva CAA. Osteomielite crônica multifocal recorrente da mandíbula: relato de três casos. J Pediatr. 2003;79(5):467-70.Sousa MV, Malheiro R, Neves J, Varandas L, Conde M. Osteomielite crónica não bacteriana unifocal da mandíbula. Acta Reumatol Port. 2014:39;94-95Kadom N, Egloff A, Obeid G, Bandarkar A, Vezina G. Juvenile mandibular chronic osteomyelitis: multimodality imaging findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(3):e38-43.Theologie-Lygidakis N, Schoinohoriti O, Iatrou I. Surgical management of primary chronic osteomyelitis of the jaws in children: a prospective analysis of five cases and review of the literature. Oral Maxillofac Surg. 2011;15(1):41-50.Wang L, Wu Y, Tan Y, Fei X, Deng Y, Cao H et al. Cytotoxic effects of the quinolone levofloxacin on rabbit meniscus cells. J Appl Toxicol. 2014;34(8):870-77.Deng Y, Chen B, Qi Y, Magdalou J, Wang H, Chen L. The effects of levofloxacin on rabbit anterior cruciate ligament cells in vitro. Toxicol Appl Pharmacol. 2011;257(1):67-73.Obel G, Krogdahl A, Thygesen T, Godballe C. Juvenile mandibular chronic osteomyelitis: 3 cases and a literature review. J Oral Maxillofac Surg. 2013;71(2):305-9.

scholarly journals 1369. The Spectrum of Chronic Osteomyelitis in Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S694-S695
Author(s):  
Marritta Joseph ◽  
Lauren Sommer ◽  
Jesus G Vallejo ◽  
Jonathon C McNeil
Keyword(s):  
Clinical Features ◽  
Hospital Admissions ◽  
Chronic Osteomyelitis ◽  
Functional Limitations ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Intravenous Therapy ◽  
Days Of Therapy ◽  
Common Etiology ◽  
Multifocal Osteomyelitis

Abstract Background While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis in children. Methods We reviewed hospital admissions with an ICD10 code for chronic osteomyelitis from 2011-2018 at Texas Children’s Hospital. Cases were included if symptoms lasted >28 days on presentation. Patients diagnosed with chronic recurrent multifocal osteomyelitis were excluded. Cases were classified as those 1) associated with a contiguous focus (CoF), 2) penetrating or open trauma, 3) orthopedic hardware (OH), 4) post-acute chronic osteomyelitis (PACO, those occurring after >28 days of therapy for acute osteomyelitis) and 5) primary hematogenous chronic osteomyelitis (PHCO, those with 28 days of symptoms without other clear risk factors). Results 114 cases met inclusion criteria. The median patient age is 11.8 years and 35.9% patients had underlying comorbidities. 83% of patients underwent a surgical procedure. Cases were diverse in terms of pathogenesis (Figure 1). A microbiologic etiology was identified in 72.8% of cases and was polymicrobial in 20.2% of cases; Staphylococcus aureus was the single most common etiology (Figure 2). CoF infection was more often associated with polymicrobial etiology with or without Pseudomonas (P< 0.001) and disease of the foot. PACO was caused by S. aureus in 95% of cases (p< 0.001, Figure 3). The overall median duration of total therapy was 210 days. 41% were discharged from hospital on OPAT with or without later transition to oral antibiotics. 26.3% of patients had persistent functional limitations at time of last follow-up of which 46% experienced repeat hospital admission/surgery. There was no association between duration of intravenous therapy and persistent functional limitations. Figure 1. Categories of Chronic Osteomyelitis Figure 2. Microbiology of Pediatric Chronic Osteomyelitis Figure 3. Clinical Features of Pediatric Chronic Osteomyelitis Conclusion Children with chronic osteomyelitis are diverse both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve functional outcomes in chronic osteomyelitis Disclosures Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

scholarly journals Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuanjun Teng ◽  
Xiaohui Zhang ◽  
Lijun Da ◽  
Jie Hu ◽  
Hong Wang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Interference Screws ◽  
Suture Group ◽  
Anterior Cruciate ◽  
Biomechanical Tests ◽  
Single Insertion

Abstract Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

scholarly journals Do Prophylactic Knee Braces Protect the Knee Against Impacts or Tibial Moments? An In Vitro Multisensory Study

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880539 ◽  
Author(s):  
Steffen Paul Hacker ◽  
Florian Schall ◽  
Frank Niemeyer ◽  
Nicolas Wolf ◽  
Anita Ignatius ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Cruciate Ligament ◽  
Joint Line ◽  
Strain Change ◽  
Posterior Direction ◽  
Knee Braces ◽  
Anterior Cruciate ◽  
The Impact ◽  
Joint Acceleration

Background: Knee braces are prescribed by physicians to protect the knee from various loading conditions during sports or after surgery, even though the effect of bracing for various loading scenarios remains unclear. Purpose: To extensively investigate whether bracing protects the knee against impacts from the lateral, medial, anterior, or posterior directions at different heights as well as against tibial moments. Study Design: Controlled laboratory study. Methods: Eight limb specimens were exposed to (1) subcritical impacts from the medial, lateral, anterior, and posterior directions at 3 heights (center of the joint line and 100 mm inferior and superior) and (2) internal/external torques. Using a prophylactic brace, both scenarios were conducted under braced and unbraced conditions with moderate muscle loads and intact soft tissue. The change in anterior cruciate ligament (ACL) strain, joint acceleration in the tibial and femoral bones (for impacts only), and joint kinematics were recorded and analyzed. Results: Bracing reduced joint acceleration for medial and lateral center impacts. The ACL strain change was decreased for medial superior impacts and increased for anterior inferior impacts. Impacts from the posterior direction had substantially less effect on the ACL strain change and joint acceleration than anterior impacts. Bracing had no effect on the ACL strain change or kinematics under internal or external moments. Conclusion: Our results indicate that the effect of bracing during impacts depends on the direction and height of the impact and is partly positive, negative, or neutral and that soft tissue absorbs impact energy. An effect during internal or external torque was not detected. Clinical Relevance: Bracing in contact sports with many lateral or medial impacts might be beneficial, whereas athletes who play sports with rotational moments on the knee or anterior impacts may be safer without a brace.

Increasing pre-activation of the quadriceps muscle protects the anterior cruciate ligament during the landing phase of a jump: An in vitro simulation

The Knee ◽  
2010 ◽  
Vol 17 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Javad Hashemi ◽  
Ryan Breighner ◽  
Taek-Hyun Jang ◽  
Naveen Chandrashekar ◽  
Stephen Ekwaro-Osire ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Quadriceps Muscle ◽  
In Vitro Simulation ◽  
Anterior Cruciate

scholarly journals Whether Sutures Reduce the Graft Laceration Caused by Interference Screw in Anterior Cruciate Ligament Reconstruction a Biomechanical Study in Vitro

2021 ◽  
Author(s):  
Yuanjun Teng ◽  
Lijun Da ◽  
Xiaohui Zhang ◽  
Hong Wang ◽  
Hua Han ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Protective Effects ◽  
Mineral Density ◽  
Interference Screws ◽  
Anterior Cruciate

Abstract Background: Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction However, previous studies h a d reported that the insertion of interference screws significantly caused graft laceration . The purpose of this study was to determine whether sutures reduce d the graft laceration from the insertion of interference screws in ACL reconstruction. Methods: Porcine tibias and bovine extensor tendons were used for establishing a knee model of ACL reconstruction in vitro . The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra high molecular weight polyethylene (UHMWPE) sutures Poly ether ether ketone (PEEK) interference screw s w ere used fortibial fixation Biomechanical tests were performed to investigate the protective effects of different sutures on grafts Results : All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre tension of the tendons, tibial bone mineral density) among all groups ( P 0.05). The biomechanical test s demonstrated that PEEK interference screw s significantly caused the graft laceration P 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction P 0.05). Conclusions : PEEK interference screw s significantly weakened the biomechanical properties of grafts during tibial fixation in ACL reconstruction. Absorbable Ethibond and UHMWPE sutures did not provide protective effects on grafts during ACL reconstruction.

POSTEROMEDIAL MENISCAL AND ANTERIOR CRUCIATE LIGAMENT STRAINS DURING DYNAMIC ACTIVITIES FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2020 ◽  
Vol 23 (02) ◽  
pp. 2050010
Author(s):  
Sebastian Tomescu ◽  
Ryan Bakker ◽  
David Wasserstein ◽  
Mayank Kalra ◽  
Micah Nicholls ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Strain Difference ◽  
Cruciate Ligament ◽  
Knee Simulator ◽  
Lower Strain ◽  
Healthy Knee ◽  
Anterior Cruciate ◽  
The Impact

Background: Meniscal strain patterns are not well understood during dynamic activities. Furthermore, the impact of ACL reconstruction on meniscal strain has not been thoroughly investigated. The purpose of this study was to characterize ACL and meniscal strain during dynamic activities and investigate the strain difference between ACL-intact and ACL-reconstructed ligament conditions. Methods: ACL and medial meniscal strain were measured in-vitro during gait, a double leg squat, and a single leg squat. For each activity kinematics and muscle forces were applied to seven cadaveric specimens using a dynamic knee simulator. Testing was performed in the ACL-intact and ACL-reconstructed ligament conditions. Results: Both the ACL and meniscus had distinct strain patterns that were found to have a significant interaction with knee angle during gait and double leg squat ([Formula: see text]). During gait, both tissues experienced lower strain during swing than stance (ACL: 3.0% swing, 9.1% stance; meniscus: 0.2% swing, 1.3% stance). Meniscal strain was not found to be different between ACL-intact and ACL-reconstructed conditions ([Formula: see text]). Conclusions: During dynamic activities, the strain in the meniscus was not altered between ACL ligament conditions. This indicates that meniscal mechanics after ACL reconstruction are similar to a healthy knee. These results help further the understanding of osteoarthritis risk after ACL reconstruction.

Sign in / Sign up

Export Citation Format

Share Document