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Wang Z, Li X, Wang Y, Fu W, Liu Y, Zhang Z, Wang C. Natural History of Type II Autosomal Dominant Osteopetrosis: A Single Center Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:819641. [PMID: 35370969 PMCID: PMC8970046 DOI: 10.3389/fendo.2022.819641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Autosomal dominant osteopetrosis II (ADO II, MIM166600) is a sclerosing bone disorder caused by CLCN7 mutation. The main clinical characteristics include minor trauma-related fracture and hip osteoarthritis, whereas cranial nerve palsy and bone marrow failure rarely develop. Although it is generally believed that ADO II has a relatively benign course, the natural course of the disease in Chinese patients remains unclear. MATERIALS AND METHODS Thirty-six patients diagnosed with ADO II in Shanghai Jiao Tong University Affiliated Sixth People's Hospital from 2008 to 2021 were studied retrospectively. Among them, 15 patients were followed for an average of 6.3 years (1-14 years). RESULTS In this study, minor trauma-related fractures of the limb were the most typical clinical manifestations. Visual loss (1/36) and bone marrow failure (2/36), was rare in this study. The condition of ADO II seems to be stable in most patients. There were no correlations between markedly elevated bone mineral density (BMD) and minor trauma-related fractures. In total, 21 diseases causing mutations were detected. Among them, the mutation c.2299C>T (p.Arg767Trp) was the most common (16.67%), and mutation c.937G>A [p.(Glu313Lys)] was associated with severe fractures, haematological defects and cranial palsy. CONCLUSIONS Minor trauma-related fracture is the most typical clinical manifestation of ADO II and always occurs in. The mutation c.2299C>T (p.Arg767Trp) is in general a relatively common variant, while the mutation c.937G>A [p.(Glu313Lys)] seems to be associated with severe phenotype. In our study, ADO II seems to remain stable over time.
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Affiliation(s)
| | | | | | | | | | | | - Chun Wang
- *Correspondence: Chun Wang, ; Zhenlin Zhang,
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Case report of osteomyelitis of the mandible in osteopetrosis and management considerations. Int J Surg Case Rep 2021; 81:105813. [PMID: 33887866 PMCID: PMC8050717 DOI: 10.1016/j.ijscr.2021.105813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/04/2021] [Accepted: 03/20/2021] [Indexed: 02/04/2023] Open
Abstract
Management guidelines in mandibular osteomyelitis in Osteopetrosis. A female patient with osteopetrosis presented osteomyelitis after teeth extraction. Our case suggests the importance to maintain at maximum existing mandibular bone. Dental prevention could reduce occurrence of osteomyelitis in Osteopetrosis.
Introduction and importance Osteopetrosis is a poorly known and probably underdiagnosed pathology. It is caused by various genetic abnormalities resulting in osteoclast dysfunction. Functional and aesthetic consequences have a major impact on the patient’s quality of life. Ten percent of osteopetrosis cases develop osteomyelitis that usually involves the mandible. Management of this complication remains complex and often unsatisfactory. Case presentation We report a case of a 62-year-old woman with osteopetrosis, complicated by mandibular osteomyelitis with intra-oral bone exposure and submental fistulas. Management was performed with antibiotic therapy and surgical necrotic resection. This cured the fistulas but the bone exposure persisted. Discussion This case report highlights the difficulty of achieving complete healing of osteomyelitis in osteopetrosis. Antibiotic therapy, surgical management, or even hyperbaric oxygen therapy are required, but must be adapted to the case. A free flap procedure is undesirable but, when it is necessary, a bone marrow transplant could be considered to restore osteoclast function. Conclusion The management of mandibular osteomyelitis in patients with osteopetrosis must adapt to the situation and severity. To avoid most cases of osteomyelitic complications in patients suffering from osteopetrosis, we propose that a preventive strategy of better dental care should be considered.
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Mikami T, Miake Y, Bologna-Molina R, Takeda Y. Ultrastructural Analyses of Alveolar Bone in a Patient With Osteomyelitis Secondary to Osteopetrosis: A Review of the Literature. J Oral Maxillofac Surg 2016; 74:1584-95. [PMID: 27000409 DOI: 10.1016/j.joms.2016.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 02/07/2023]
Abstract
Osteopetrosis is a generic term for generalized sclerotic conditions caused by rare genetic disorders. Decreased osteoclastic activities disturb bone remodeling, resulting in greater mineral density and greater compressive strength; therefore, bone fracture is a major physical symptom of osteopetrosis. Osteomyelitis of the maxilla or mandible is a common and well-documented complication of osteopetrosis. Local infection, such as odontogenic infection, is more likely to lead to osteomyelitis, and treatment strategies can be challenging. However, detailed ultrastructural analyses of bone from patients with osteopetrosis and odontogenic infection are limited. This report describes a case of osteomyelitis of the maxilla and mandible secondary to osteopetrosis in an adult patient and presents ultrastructural data of alveolar bone tissue analyzed by contact microradiography, electron probe microanalysis, and x-ray diffraction. Cases of osteomyelitis of the jaw secondary to osteopetrosis also are reviewed.
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Affiliation(s)
- Toshinari Mikami
- Associate Professor, Division of Anatomical and Cellular Pathology, Department of Pathology, Iwate Medical University, Iwate, Japan.
| | - Yasuo Miake
- Associate Professor, Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan
| | - Ronell Bologna-Molina
- Professor, Molecular Pathology Area, School of Dentistry, Universidad de la Republica, Montevideo, Uruguay
| | - Yasunori Takeda
- Professor, Division of Anatomical and Cellular Pathology, Department of Pathology, Iwate Medical University, Iwate, Japan
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Palla B, Burian E, Klecker JR, Fliefel R, Otto S. Systematic review of oral ulceration with bone sequestration. J Craniomaxillofac Surg 2015; 44:257-64. [PMID: 26782844 DOI: 10.1016/j.jcms.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 11/25/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This article represents the first systematic review entirely dedicated toward a disease called oral ulceration with bone sequestration (OUBS). We performed this review in order to further define and outline this disease. A secondary interest was to recognize the prevalence and importance of OUBS in relation to other oral disorders accompanied by ulceration and bone exposure. MATERIAL AND METHODS The systematic review was registered with PROSPERO (registration number CRD42015024294) and performed in cooperation with Harvard's Countway Library. Searches were built using MeSH terms and proximity operators previously mentioned in OUBS descriptions. Database searches were performed through EMBASE, Medline, and PubMed, followed by a handsearch of bibliographies for relevant articles. Articles were assessed against eligibility and inclusion criteria centering on bone exposure without known etiologic cause. We sought to gather information on patient age, sex, anatomical location, clinical presentation, and comorbidities. PRISMA guidelines were followed. RESULTS The searches identified 766 records total. Despite considerable inspection, we found only 8 articles qualifying for our review. In the 8 articles, there were a total of 24 patients fulfilling the criteria of OUBS. Although some abstracts mentioned idiopathic nature, most authors presented clinical cases with probable causes to ulceration and sequestration. The mean age of these patients was 43.21 ± 11.94 years. The male to female ratio was 3:1. The predominant area of occurrence was the mandible (n = 23, 95.8%). CONCLUSION The representation of OUBS in the literature remains scarce. More data must be generated and gathered on the concept of OUBS so as to determine the true incidence and importance of this disease. Despite rare occurrences of conditions characterizing OUBS, the recent discussion of this topic in the scientific community calls for more knowledge to be brought forth, with great benefit to patients suffering from ulcerative diseases and osteonecrosis.
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Affiliation(s)
| | - Egon Burian
- Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. Michael Ehrenfeld), Ludwig-Maximilians-Universität, Munich, Germany; Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Munich, Germany; Department of Oral & Maxillofacial Surgery, Alexandria University, Alexandria, Egypt
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. Michael Ehrenfeld), Ludwig-Maximilians-Universität, Munich, Germany.
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Abstract
Osteopetrosis is a heterogeneous disorder characterized by abnormal bone remodeling and increased bone density primarily due to defective osteoclast resorption. The diagnosis is based on a history of numerous fractures and radiological findings indicative of osteosclerosis, usually sufficient for a definitive diagnosis. We present a quite rare case of osteopetrosis complicated by recurrent episodes of maxillomandibular osteomyelitis associated with cutaneous fistulization and purulent nasal discharge. We used intravenous antibiotic therapy and necrotic bone debridement that prevented the appearance of acute infections over a 3-year follow-up, but the complete healing of the case was not achieved.
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Kulyapina A, Verdaguer Martin J, Navarro Cuellar C, Navarro Vila C. Long-Term Follow-Up of Bimaxillary Osteomyelitis Associated with Autosomal Dominant Osteopetrosis: A Case Report. J Maxillofac Oral Surg 2015; 15:121-6. [PMID: 26929564 DOI: 10.1007/s12663-015-0749-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022] Open
Abstract
Osteopetrosis (OP) is a rare metabolic bone disease characterized by a generalized increase in skeletal mass. The disease is characterized by increased susceptibility to develop osteomyelitis of the jaws. We report a case of clinical and radiological progression of bimaxillary osteomyelitis in a patient with autosomal dominant OP. The patient presented non simultaneous osteomyelitis in both upper and lower jaws with time interval of 10 years. The osteomyelitis of maxilla resulted in oroantral fistula formation and required surgical closure with Bichat fat pad flap. The mandibular osteomyelitis resulted in sequestra formation and pathological fracture and required multiple debridement procedures. Both maxillary and mandibular osteomyelitic foci were persistent and healing required more than 2 years. The case confirms the possibility of development of non simultaneous bimaxillary osteomyelitis in patients with OP. The case enhances the need of close follow- up and preventive measures in patients with OP.
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Affiliation(s)
- A Kulyapina
- Department of Maxillofacial Surgery, Gregorio Marañón General University Hospital, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - J Verdaguer Martin
- Department of Maxillofacial Surgery, Gregorio Marañón General University Hospital, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - C Navarro Cuellar
- Department of Maxillofacial Surgery, Gregorio Marañón General University Hospital, C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - C Navarro Vila
- Department of Maxillofacial Surgery, Gregorio Marañón General University Hospital, C/Doctor Esquerdo 46, 28007 Madrid, Spain
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García CM, García MAP, García RG, Gil FM. Osteomyelitis of the mandible in a patient with osteopetrosis. Case report and review of the literature. J Maxillofac Oral Surg 2013; 12:94-9. [PMID: 24431821 PMCID: PMC3589508 DOI: 10.1007/s12663-011-0196-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 03/03/2011] [Indexed: 10/18/2022] Open
Abstract
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.
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Affiliation(s)
- Carlos Moreno García
- />Department of Oral and Maxillofacial Surgery-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain
| | | | - Raúl González García
- />Department of Oral and Maxillofacial Surgery-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain
| | - Florencio Monje Gil
- />Department of Oral and Maxillofacial Surgery-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain
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Sharma SS, Saravanan C, Sathyabama V, Satish C. Osteopetrosis of the mandible masquerading as tubercular osteomyelitis. BMJ Case Rep 2013; 2013:bcr-2012-007487. [PMID: 23314447 DOI: 10.1136/bcr-2012-007487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Osteopetrosis is a rare congenital (autosomal type) disorder of the skeletal system. Several variants have been described in the literature with grossly variant prognosis and clinical behaviour. Several reports of intractable osteomyelitis of the jaw bones secondary to osteopetrosis, particularly the mandible, have been published widely. However, there is no published report of the complete mandible sequestrating de novo, in the literature. An overview of this spectrum of sclerotic bone disease, its presentation in the oro-facial region, the diagnostic challenge it poses and the management dilemma it offers to the maxillofacial surgeon is discussed and a protocol for managing this disease effectively is presented. A clinical illustration of the complexities of management of osteopetrosis-induced osteomyelitis of jaw bones is demonstrated with a very rare case in which the entire mandible had sequestrated.
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Affiliation(s)
- Subramanya S Sharma
- Department of Oral & Maxillofacial Surgery, Aadhiparasakthi Dental College & Hospital, Melmaruvathur, Tamilnadu, India.
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Tohidi E, Bagherpour A. Clinicoradiological findings of benign osteopetrosis: report of two new cases. J Dent Res Dent Clin Dent Prospects 2012; 6:152-7. [PMID: 23277863 PMCID: PMC3529930 DOI: 10.5681/joddd.2012.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 09/10/2012] [Indexed: 11/17/2022] Open
Abstract
Osteopetrosis represents a heterogeneous group of rare, hereditary bone dysplasias that share the hallmark of increased bone density caused by osteoclast dysfunction. It can manifest through a spectrum of symptoms and severity, from neonatal onset with life-threatening complications ("malignant" autosomal recessive osteopetrosis) to two more benign conditions with the incidental radiographic findings, principally affecting adults (autosomal dominant osteopetrosis type I and type II). We report 2 new cases of autosomal dominant osteopetrosis type II. Both subjects were short in stature. Multiple healed fractures of long bones, diminished marrow spaces and hypoplastic maxillary sinuses were remarkable findings. To our knowledge they are the first reported cases of autosomal dominant type II of this disease in Iran.
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Affiliation(s)
- Elahe Tohidi
- Assistant Professor, Department of Oral Radiology, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
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Marginal resection for treatment of mandibular osteomyelitis associated with osteopetrosis: Case report. J Craniomaxillofac Surg 2011; 39:525-9. [DOI: 10.1016/j.jcms.2010.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 10/04/2010] [Accepted: 10/06/2010] [Indexed: 11/21/2022] Open
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Kos M, Brusco D, Kuebler J, Engelke W. Clinical comparison of patients with osteonecrosis of the jaws, with and without a history of bisphosphonates administration. Int J Oral Maxillofac Surg 2010; 39:1097-102. [DOI: 10.1016/j.ijom.2010.04.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 03/19/2010] [Accepted: 04/21/2010] [Indexed: 11/30/2022]
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Casse G, Magy L, Vallat JM, Adenis JP, Robert PY. [Albers-Schönberg's disease with ocular manifestation]. J Fr Ophtalmol 2010; 33:655.e1-9. [PMID: 20846745 DOI: 10.1016/j.jfo.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 07/01/2010] [Indexed: 11/18/2022]
Abstract
Albers-Schönberg's disease is a rare disease (one case in 100,000 inhabitants), asymptomatic in the majority of cases. It belongs to the four clearly individualized forms of human osteopetrosis and has an autosomal dominant transmission. It induces generalized osteosclerosis, and most symptoms result from complications such as fractures following mild injury, compression of cranial nerves, especially the optic nerve, by stenosis of extracranial ostia, but also osteomyelitis of the lower maxilla. The treatment of Albers-Schönberg's disease is disappointing and only symptomatic, although the responsible genetic anomaly was recently identified. We report here the case of a 54-year-old woman, whose diagnosis of the disease has been known since adolescence, who presented with unilateral loss of vision and perimetric deficit due to papilla edema resulting from stenosis of the optic canal and benign intracranial hypertension.
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Affiliation(s)
- G Casse
- Service d'ophtalmologie, hôpital Dupuytren, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
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Yamada T, Mishima K, Imura H, Ueno T, Matsumura T, Moritani N, Sugahara T. Osteomyelitis of the mandible secondary to infantile osteopetrosis: A case report. ACTA ACUST UNITED AC 2009; 107:e25-9. [DOI: 10.1016/j.tripleo.2009.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 01/04/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Vázquez E, López-Arcas JM, Navarro I, Pingarrón L, Cebrián JL. Maxillomandibular osteomyelitis in osteopetrosis. Report of a case and review of the literature. Oral Maxillofac Surg 2009; 13:105-108. [PMID: 19219469 DOI: 10.1007/s10006-009-0151-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Osteopetrosis is a rare hereditary group of bony displasias. They range from a devastating metabolic disease (including severe malignant infantile osteopetrosis) to other conditions with a more benign phenotype (autosomal dominant osteopetrosis I and II). CASE REPORT Several case reports have been published of infectious complications affecting the mandible but maxillary affectation is quite rare. We present the case of a 23-year-old woman with a malignant recessive form of osteopetrosis complicated by repeated episodes of osteomyelitis (caused by actinomyces) of the mandible and maxilla.
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Affiliation(s)
- E Vázquez
- Department of Oral and Maxillofacial Surgery, University Hospital La Paz, Madrid, Spain
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Kos M, Łuczak K, Engelke W. Controversial role of bisphosphonates in osteonecrosis of the jaws. Otolaryngol Pol 2009. [DOI: 10.1016/s0030-6657(09)70068-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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