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Reiss S, Kulker D, Laure B, Paré A. Reconstruction of the orbitozygomatic framework: State of the art and perspectives. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101788. [PMID: 38281701 DOI: 10.1016/j.jormas.2024.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 01/30/2024]
Abstract
The reconstruction of the whole orbitozygomatic framework (OZF) is complex and can be encountered in cases of congenital midface deformity, after tumor ablative surgery and in severe facial trauma. Nowadays, surgeon has a wide range of available techniques that have continually grown over the past years, optimizing the surgical management and the aesthetical outcomes. Among them, the autologous bone graft (ABG) remains one of the most suitable options : ABG is easy to harvest and has optimal biological properties for bone healing. It can be tailored to the patient anatomy thanks to the recent advances in computer-assisted surgery. However, substantial drawbacks remain such as the early resorption of the non-vascularized graft, the need of a donor site and its potential morbidity. Alloplastic reconstruction is another option that can resolve both the resorption issue and the donor site morbidity. Moreover, the 3D-printing technologies also allows the manufacturing of patient specific implants. However, alloplastic materials have a variable success, especially due to the high risk of infection or exposure. Consequently, regenerative medicine is a promising field that aims to find a procedure without the disadvantages of ABG or alloplastic based reconstructions, but displaying similar or even higher success rate. Indeed, recent tissue engineering strategies have demonstrated encouraging results for bone regeneration using natural or synthetic biomaterials, patient cells and synthetic bioactive substances. The objective of this review is to present the etiologies of OZF defect, the available reconstruction procedures as well as the current state of the research.
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Affiliation(s)
- Ségolène Reiss
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Dimitri Kulker
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Boris Laure
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France
| | - Arnaud Paré
- Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Reference Center for rare Craniostenoses and Craniofacial Malformations CRANIOST, Avenue de la République, Tours, 37044, France.
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Papadakis SA, Gourtzelidis G, Pallis D, Ampadiotaki MM, Tatakis F, Tsivelekas K, Georgousi K, Kokkinis C, Diamantopoulou K, Lelekis M. Cryptococcus neoformans osteomyelitis of the tibia: a case report and review of the literature. J Med Case Rep 2023; 17:188. [PMID: 37149631 PMCID: PMC10164329 DOI: 10.1186/s13256-023-03925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Osteomyelitis is a bone inflammation that can be related to various infectious agents. As with any other type of inflammation, the prevailing symptoms and signs may include redness, swelling, pain, and heat. Fungal osteomyelitis is rare and usually found in immune-compromised patients. CASE PRESENTATION A non-human immunodeficiency virus immunocompromised Greek female patient, 82 years old, visited the emergency department due to a 3 day pain located mainly over the left tibia's anterior surface, accompanied by swelling and redness. There was also a subcutaneous lesion of her left breast. Medical history revealed that the patient had an unmasked close contact with pigeons, a main host of the disease. Initial x-ray imaging showed an osteolytic area in the upper third of the tibial diaphysis. The patient was admitted and underwent a computed tomography-guided biopsy. The specimen revealed a Cryptococcus neoformans infection of the bone and the breast. She was treated with 400 mg fluconazole twice a day for 3 weeks while in hospital and 200 mg twice a day upon discharge for 9 months. After that, she underwent surgical debridement because of lasting local irritation. She was closely monitored in our outpatient office, and in her last visit, 1 year after the initial admission, inflammatory signs had regressed vastly. CONCLUSIONS To our knowledge, this is the ninth cryptococcal osteomyelitis of the tibia to be recorded since 1974, and the most unusual finding was the bifocal nature of the infection, affecting both the tibia and the breast.
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Affiliation(s)
- Stamatios A Papadakis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece.
| | - Georgios Gourtzelidis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | - Dimitrios Pallis
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | | | - Fotios Tatakis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
| | - Konstantinos Tsivelekas
- B' Department of Orthopaedics, KAT General Hospital of Attica, 2 Nikis Street, 14561, Kifisia, Greece
| | - Kleoniki Georgousi
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
| | | | | | - Moyssis Lelekis
- Department of Internal Medicine, KAT General Hospital of Attica, Kifisia, Greece
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Zhong Y, Huang Y, Zhang D, Chen Z, Liu Z, Ye Y. Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review. BMC Infect Dis 2023; 23:116. [PMID: 36829132 PMCID: PMC9960465 DOI: 10.1186/s12879-023-08066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Cryptococcus neoformans, an opportunistic fungal pathogen, seldom causes infection in immunocompetent people. Cryptococcal osteomyelitis is an uncommon condition in which Cryptococcus invades the bone. It usually occurs as part of a disseminated infection and rarely in isolation. The spine has been reported as the most common site of cryptococcal osteomyelitis; however, isolated case of sacrum involvement in immunocompetent patients has never been reported. CASE PRESENTATION We report the case of a 37-year-old man without underlying disease who presented with progressive low back and sacrococcygeal pain. The patient was initially diagnosed with sacral tumour by a local doctor, and subsequently, after admission, was diagnosed with sacral tuberculosis. He was empirically treated with antitubercular drugs. The patient failed to respond to antitubercular drugs and complained of worsening low back pain. Additionally, he developed persistent radiating pain and numbness in his legs. For further diagnosis, we performed a computed tomography-guided puncture biopsy of the sacrum, which revealed granulomatous inflammation with massive macrophage infiltration and special staining revealed a fungal infection. We performed sacral debridement and drainage and obtained purulent specimens for pathological examination and microbial culture. Microbial identification and drug susceptibility tests revealed a Cryptococcus neoformans infection sensitive to fluconazole. Postoperatively, the persistent radiating pain and numbness in the legs resolved. After 12 consecutive weeks of antifungal therapy, all his symptoms resolved. The patient remained without any signs of recurrence at the 8-month follow-up. CONCLUSION We reported a rare case of isolated sacrum cryptococcal osteomyelitis in an immunocompetent patient. Furthermore, we identified and reviewed 18 published cases of spine cryptococcal osteomyelitis. Immunocompetent individuals are also at risk for cryptococcal osteomyelitis. Clinical manifestation and imaging are insufficient to diagnose cryptococcal osteomyelitis of the spine, and invasive examinations, such as puncture biopsy and fungal examinations, are needed. Antifungal therapy yields satisfactory results for the treatment of cryptococcal osteomyelitis of the spine, however, if the infective lesion is large, especially when it compresses the spinal cord and nerves, a regimen combining aggressive surgery with antifungal therapy is indispensable.
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Affiliation(s)
- Yanchun Zhong
- grid.452437.3Department of Orthopaedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000 People’s Republic of China
| | - Yuxi Huang
- Department of Basic Medicine, Gannan Healthcare Vocational College, Ganzhou, 341000 People’s Republic of China
| | - Di Zhang
- grid.452437.3Department of Medical Imaging, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000 People’s Republic of China
| | - Zhaoyuan Chen
- grid.452437.3Department of Orthopaedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000 People’s Republic of China
| | - Zhenxing Liu
- grid.452437.3Department of Orthopaedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000 People’s Republic of China
| | - Yongjun Ye
- Department of Orthopaedics, First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, People's Republic of China.
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Cheng J, Zhang L, Huang Q, Li C, Yu J, Zhu M. Refractory Osteomyelitis Caused by Mycobacterium aubagnense and Its L-Form: Case Report and Review of the Literature. Infect Drug Resist 2022; 15:7317-7325. [DOI: 10.2147/idr.s388629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
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He S, Luo T, Xie Y, Zhu X, Lei J, Cai L, Deng Z. Pubis Cryptococcal Osteomyelitis in an Immunocompetent Patient: A Case Report and Recent Literature Review. Infect Drug Resist 2022; 15:7369-7375. [DOI: 10.2147/idr.s390881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
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Cleveland KO, Mazumder SA, Animalu C, Gelfand MS. Cryptococcal osteomyelitis in immunocompetent hosts. Am J Med Sci 2022; 364:673. [PMID: 35787361 DOI: 10.1016/j.amjms.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Kerry O Cleveland
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Shirin A Mazumder
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chinelo Animalu
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael S Gelfand
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Datarkar AN, Daware S, Gadve V, Pardiwala AF, Pund M, Bhawalkar A, Purohit S, Relan P, Ghormade A. Zygomaticomaxillary Osteomyelitis due to COVID-19 Associated Mucormycosis (CAM): A Case Series of 10 Patients. J Maxillofac Oral Surg 2022:1-11. [PMID: 36267537 PMCID: PMC9568929 DOI: 10.1007/s12663-022-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/04/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies. Methods A standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS). Results Ten out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%. Conclusions The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.
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Affiliation(s)
- Abhay N. Datarkar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Surendra Daware
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Vandana Gadve
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Arwa F. Pardiwala
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Mahesh Pund
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Amit Bhawalkar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Subodh Purohit
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Priyanka Relan
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
| | - Ashlesha Ghormade
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Hanuman Nagar, Medical Chowk, Nagpur, Maharashtra 440003 India
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Naujokat H, Loger K, Gülses A, Flörke C, Acil Y, Wiltfang J. Effect of enriched bone-marrow aspirates on the dimensional stability of cortico-cancellous iliac bone grafts in alveolar ridge augmentation. Int J Implant Dent 2022; 8:34. [PMID: 36063250 PMCID: PMC9445114 DOI: 10.1186/s40729-022-00435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background The objective of the current study was to assess the clinical and radiological outcomes following autologous grafting from the iliac crest treated with autologous stem cells in-situ to reduce the postoperative bone graft resorption rate. Materials and methods The study group consisted of patients who underwent vertical augmentation of the jaws via bone grafts harvested from the iliac crest enriched with bone-marrow aspirate concentrates (stem cell group). The first control group (control) included 40 patients underwent a vertical augmentation with autologous bone grafts from the iliac crest. In the second control group, 40 patients received identical surgical procedure, whereas the autologous bone graft was covered with a thin layer of deproteinized bovine bone matrix and a collagen membrane (DBBM group). Clinical complications, implant survival, radiological assessment of the stability of the vertical height and histological evaluation at the recipient site have been followed up for 24 months postoperatively. Results No differences in terms of implant survival were observed in the groups. In the stem cell group, the resorption after 4–6 months was 1.2 ± 1.3 mm and significantly lower than the resorption of the control group with 1.9 ± 1.6 mm (P = 0.029) (DBBM group: 1.4 ± 1.2 mm). After 12 months, the resorption of the stem cell group was 2.1 ± 1.6 mm and significantly lower compared to the control group (4.2 ± 3.0 mm, P = 0.001) and DBBM group (resorption 2.7 ± 0.9 mm, P = 0.012). The resorption rate in the second year was lower compared to the first year and was measured as 2.7 ± 1.7 mm in the stem cell group (1-year bone loss in the time period of 12–24 months of 0.6 mm compared to 2.1 mm in the first 12 months). The resorption was significantly lower compared to the control group (4.7 ± 2.9 mm; P = 0.003, DBBM group: 3.1 ± 0.5 mm, P = 0.075). Conclusions Autologous bone-marrow aspirate concentrate could enhance the dimensional stability of the bone grafts and improve the clinical standard of complex reconstruction of the alveolar ridge. Even though the intraoperative cell enrichment requires an additional equipment and technical specification, it represents an alternative method for in-situ regeneration by osteogenic induction with a contribution of a manageable cost factor.
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Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany.
| | - Klaas Loger
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Yahya Acil
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Head: Prof. Dr. Dr. Jörg Wiltfang), Arnold-Heller-Straße 3, Haus B, Kiel, Germany
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