Ameloblastic fibroma: a peculiar clinical course

Abstract

Background: Chronic osteomyelitis; defined as osteomyelitis that is present for more than four weeks, can be difficult to manage. We present a case of chronic osteomyelitis managed using a targeted antibiotic regime only. Surgery was not required. Case Report: A 67-year-old female patient presented complaining of recurrent right-sided mandibular swelling and associated lip numbness, following extraction of the lower right second premolar. She was allergic to penicillin.On examination, she had right-sided facial swelling and a sublingual extraoral fistula. She had swelling both buccal and lingual to the extraction site.Dental panoramic tomography (DPT) radiograph showed a 1 cm diffuse moth-eaten radiolucency in the lower right premolar region. A computed tomography (CT) scan of the mandible showed osteomyelitis of the mandible, involving the inferior alveolar nerve canal. To confirm the diagnosis, SW underwent urgent bone biopsy, which revealed a chronic osteomyelitis process.Culture and sensitivity revealed a rare combination of microorganisms -Candida dubliniensis, Streptococcus anginosus and Streptococcus mitis. We liaised with the microbiology team who recommended an initial six-week course of clarithromycin and fluconazole. Later, a four-week course of linezolid was prescribed. SW was monitored closely and a final DPT showed substantial reduction in the radiolucent area. Conclusion:Although osteomyleitis is uncommon in developed countries, it is prevalent and often difficult to distinguish from osteoradionecrosis, if correctly identified and managed then this can prevent disease progression and surgical intervention. A close relationship with the microbiology team aided effective management of this case.