Garré's Sclerosing Osteomyelitis with Perimandibular Soft Tissue Inflammation and Fistula

Garré's sclerosing osteomyelitis is a form of chronic osteomyelitis that commonly affects children and young adults. Here, we report one such case of Garré's sclerosing osteomyelitis in a 20-year-old female who presented with facial asymmetry and inability to open mouth. On clinical examination, it was bony hard swelling with trismus. History of infected second molar tooth extraction was present. Computed tomography scan showed thickening and sclerosis of the ramus and condylar process of mandible, on right side, with proliferative periostitis. Magnetic resonance imaging showed soft tissue edema and inflammation, in the form of enlargement of right masseter and pterygoid muscles with intramuscular fluid collection. On the basis of history, clinical signs, and imaging features, diagnosis of Garré's osteomyelitis with fascial space infection was made. To our knowledge, very few cases of Garré's osteomyelitis present with superimposed fascial space infection, as it is otherwise a nonsuppurative condition. Fistula formation is a very rare incidence as it is seen in our case.

Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly

Objective. To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome. Methods. A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n = 53) and the observation group (n = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups. Results. There was no statistical difference in the success rate of one-time operation between the two groups ( P > 0.05 ). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant ( P < 0.05 ). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant ( P < 0.05 ). Conclusion. Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.

Multifunctional Irrigation-Assisted Vacuum Drainage versus Traditional Drainage in the Treatment of Odontogenic Deep Fascial Infection: A Retrospective Cohort Study

Background: Odontogenic deep fascial space infection in the head and neck is a common clinical problem which requires emergency surgery. Traditional drainage method is considered laborious and gravity-dependent. We aimed in this study to promote a modified multifunctional irrigation-assisted vacuum drainage (MIVD) and evaluate the clinical effect of it in the treatment of odontogenic deep fascial infection.Methods: Patients diagnosed with odontogenic deep fascial space infection in the Second Affiliated Hospital, Zhejiang University School of Medicine, China between March 2018 and March 2021 were studied. We divided the patients into two groups based on the drainage method they received: patients with the MIVD device were included in the MIVD group, patients with traditional drainage were included in the traditional group. Data was collected retrospectively including baseline characteristics and treatment outcome variables. Pearson Chi-square test and the Student t-test were used in statistical analyses. Statistical difference was considered significant when p<0.05.Results: A total of 65 patients were included. All the patients were eventually cured. There were no significant differences in age, gender, systemic diseases, history of diabetes, tobacco use, number of the infected spaces, preoperative white blood cell count and C-reactive protein between the two groups (p>0.05). The number and frequency of manual irrigation by clinicians (MIC), time required for white blood cell count to return to normal levels (TWBC), time required for C-reactive protein to return to normal levels (TCRP), the length of hospitalization and the length and total cost of antibiotics use were significantly less in the MIVD group than those in the traditional group (p<0.05). There was no significant difference in the cost of hospitalization between the 2 groups (p>0.05).Conclusions: The MIVD device significantly reduced the number and frequency of MIC, TWBC, TCRP, the length of hospitalization and the length and total cost of antibiotics use in comparison with the traditional drainage method. It provided a favorable treatment method for patients with odontogenic deep fascial space infection in the head and neck.

Odontogenic Cervicofacial Infection in Pregnancy: A Need for Oral Care

Objective: During pregnancy, changes occur in the oral environment with gingivitis predominating. The development of odontogenic infections within the period of pregnancy may endanger the life of the mother as well as that of her unborn baby. Materials and methods: A retrospective observational study of cases of cervicofacial infection in women during pregnancy was conducted at the oral and maxillofacial surgery clinic of a northern Nigerian tertiary health care center from January 2006 to June 2018. Results: Seventy women were managed for cervicofacial infection during the period reviewed, out of which 20 women (28.6%) presented during pregnancy. Their mean age was 33.8 ± 9.35 years with a range of 20 to 55 years. The 30-39 years age bracket had the highest frequency (40%) and the mean duration of pregnancy at presentation was 24.9 ± 11.12 weeks with a range between 10 to 36 weeks. Majority (n=15, 75.0%) presented in the 3rd trimester. At presentation, the frequently involved fascial space was unilateral submandibular space (n=10; 50.0%), All the patients had incision/drainage/decompression on the dental chair under local anesthesia (2% lidocaine with 1:80,000 adrenaline). The mean length of hospital stay was 13.9 ± 6.2 days with a range of 6 to 26 days. The mortality rate was 15% (n=3 cases). Conclusion: There is a need for oral health evaluation in pregnant women during ante-natal visits to prevent these complications. Oral health education should also form part of teachings received by women both in the ante-natal and postnatal clinics.

MRSA infection of masticatory spaces in a paediatric patient

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.