Osteomyelitis of the mandible leading to pathological fracture in a tuberculosis patient: A case report and review of literature

Abstract

Osteomyelitis is an inflammatory condition of the bone, beginning in the medullary cavity and haversian systems and extending to involve the periosteum of the affected area. Although other etiological factors, such as traumatic injuries, radiation, and certain chemical substances, among others, may also produce inflammation of the medullary space, the term "osteomyelitis" is mostly used in the medical literature to describe a true infection of the bone induced by pyogenic microorganisms. Tuberculous osteomyelitis is an uncommon disease entity. Here, we present a case of osteomyelitis of mandible leading to pathological fracture of mandible, in which pulmonary tuberculosis involvement was detected only subsequently. The oral physicians thus play a crucial role in recognizing high-risk patients and initiating prompt isolation and evaluation.

A case report of chronic intermedullary inflammation of bone in a child

“…As this continues to accumulate, the periosteum is breached and followed by the development of mucosal or cutaneous abscesses and fistula. [ 13 14 15 ]…”

Orofacial tuberculosis: Clinical manifestations, diagnosis and management

“…Jaw involvement is even rarer. [ 19 ] The mandibular involvement is more frequent than maxilla and alveolar and angle regions have greater affinity. [ 20 ] Tuberculous osteomyelitis commonly affects the adults; however, in some cases children are also affected.…”

“…[ 21 ] The spread of infection may be by direct transfer from infected sputum,[ 22 ] through an extraction socket or mucosal opening associated with an erupting tooth or by regional extensions of soft tissue lesions to underlying bone or by hematogenous spread. [ 19 ] Chapotel[ 22 ] described four clinical forms of TB of the mandible. The first is the superficial or alveolar form that involves the alveolar process, second is the deep or central form in which the angle of the mandible is involved, third is the diffuse form characterized by progressive extensive necrosis of mandible that might involve the TMJ and the fourth one is acute osteomyelitis form.…”

A unique case of mandibular osteomyelitis arising from tooth germ infection in a 7,000-year-old infant from Siberia

“…However, lesions usually occur in the cranial vault (because of bacilli localization in the diploe), sometimes with hypervascular lesions on the endocranial surface (Mukherjee et al, 2002;Pálfi et al, 2012), and children are more likely to have lesions in several bones (Messner, 1987;Gupta and Singh, 2007), both features lacking in this case. Gadgil et al (2012) estimate that less than two percent of the roughly five to seven percent of tuberculosis cases that result in skeletal lesions are located in the mandible (<0.10 to 0.14%) (also see Erasmus et al, 1998). Ortner (2003) notes that TB lesions in the mandibulae of children are located near the angle, again dissimilar to the lesion in question.…”