Florencio Monje Gil

Osteomyelitis of the Mandible in a Patient with Osteopetrosis. Case Report and Review of the Literature

Osteopetrosis is a rare hereditary bone disorder presenting with variable clinical features and is characterized by an increase in bone density and reduction of marrow spaces that result from a defect in the function of osteoclasts and, consequently, a decrease in bone turnover. This disease is generally divided into three types: severe infantile malignant autosomal recessive, intermediate mild autosomal recessive, and benign autosomal dominant. The prognosis of the first two types is very poor and is characterized by an early onset, usually within the first decade of life, and early death. The benign-type is characterized by a later onset and a longer life span. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. The osteomyelitis is generally caused by tooth extraction or pulpal necrosis. The leading cause of the increased rate of infection is thought to be a lack of adequate bone vasculature. Treatment of osteomyelitis secondary to osteopetrosis is controversial. Treatment regimens include high-dose systemic antibiotics coupled with thorough debridement of necrotic bone and primary closure of soft tissues, if possible. Hyperbaric oxygen has been used for the treatment of chronic osteomyelitis.

Mucormycosis of the head and neck: Report of five cases with different presentations

Mucormycosis is a lethal fungal disease with a general poor prognosis. Rhinocerebral presentation is the more frequent form. The purpose of this study was to review and show our experience in the management of 5 cases of mucormycosis of the head and neck with different clinical presentations. The high suspicion led us a prompt diagnosis and aggressive surgical treatment that allowed a good outcome in our series.

Effects of bilateral discectomy and bilateral discopexy on black Merino sheep rumination kinematics: TEMPOJIMS – phase 1 – pilot blinded, randomized preclinical study

BACKGROUND The temporomandibular joint interposal study (TEMPOJIMS) is a rigorous preclinical trial divided in 2 phases. In phase 1 the authors investigated the role of the TMJ disc and in phase 2 the authors evaluated 3 different interposal materials. The present work of TEMPOJIMS - phase 1, investigated the effects of bilateral discectomy and discopexy in sheep mastication and rumination. METHODS This randomized, blinded and controlled preclinical trial (in line with the ARRIVE guidelines) was conducted in 9 Black Merino sheep to evaluate changes in mastication and rumination after bilateral discectomy and bilateral discopexy, by comparing with a sham surgery control group. The outcomes evaluated were: (1) absolute masticatory time; (2) ruminant time per cycle; (3) ruminant kinematics, and (4) ruminant area. After baseline evaluation and surgical interventions, the outcomes were recorded over 3 successive days, every 30 days, for 6 months. RESULTS The first month after intervention seemed to be the critical period for significant kinematic changes in the discectomy and discopexy groups. However, 6 months after the bilateral interventions, no significant changes were noticed when compared with the control group. CONCLUSIONS In this study, bilateral discectomy and discopexy had no significant effect in mastication and ruminatory movement. The introduction of kinematic evaluation presents a new challenge that may contribute to the improvement of future studies on the TMJ domain.

Lemierre syndrome: headache and proptosis as unusual presentation of dental infection by Gemella morbillorum.

Lemierre syndrome has usually been related to oropharyneal infection by Fusobacterium necrophorum. We describe rare case with symptoms of headache and proptosis secndary to odontogenic infection by Gemella morbillorum. To ur knowledge, no previous case of Lemierre syndrome with his aetiology and clinical presentation has been described. A 59-year-old man was admitted to the emergency departent with trismus, headache, and proptosis of his left eye. ntraoral inspection showed trismus of 2 fingerbreadths and n infected mouth with poor dental hygiene. A vertical rigid ainful “cord” was palpated along the whole anterior border f the right sternocleidomastoid muscle. Contrast-enhanced omputed tomography (CT) and magnetic resonance imagng (MRI) showed an abscess in the right pterygomaxillary egion, thrombophlebitis of the left internal jugular vein, nd thrombosis of the left ophthalmic vein with proptosis Figs. 1 and 2). The right pterygomaxillary collection was drained intraoally and involved teeth were removed. Postoperative CT howed a substantial reduction in the abscess in the pteryomaxillary space, but bilateral nodular formations in the hest compatible with septic emboli. Microbiological culures grew multisensitive G morbillorum. He progressed avourably on piperacillin/tazobactam (4 g/500 mg every 8 h) nd linezolid (600 mg every 12 h), given intravenously and as discharged to his local hospital until he had recovered ompletely. Lemierre syndrome is a rare but serious disease usully associated with oropharyngeal infection.1 Diagnosis is ainly decided by clinical findings related to the infecion (fever (in a 82.5% of cases), sore throat, trismus, pain nd swelling or induration at the angle of the mandible nd along the sternocleidomastoid muscle), and by imagng showing thrombophlebitis of the internal jugular vein, eptic emboli, or pulmonary infarcts.2 Final diagnosis is con-