全下顎骨에 發生된 骨髓炎의 治験例

A CASE REPORT OF OSTEOMYELITIS OF THE WHOLE MANDIBLE

We have met a 18-year-old man with osteomyelitis of the whole mandible resulting in facial disfigurement due to multiple fistulous scar bands & several operation scars. He had noted the history of the disease over the past 10 years and complained the almost complete limitation of mouth opening combined by intermittent TMJ pain. We used the conservative sugical treatment, seguestrectomy and packing open, instead of using the mandibulectomy, considering the age of the patient, economic status, expected functional and psychologic derangement and reconstruction problems. We have followed the patient for four and a half months by clinical and radiographic examinations and the results were as follows; 1. It has been possible to treat osteomyelitis of the whole mandible by sequetrectomy & packing open although it was considered that total mandibulectomy was indicated. 2. It is thought that the age of the patient, conservation of the periosteum and existing infection were important for the regeneration of bone. 3. This case has shown that deferred diagnosis, indefinte treatment and inadeguate overuse of antibiotics aggravated the propagation of the infection. 4. Periodic pus culture, antibotic sensitivity test and proper choice of antibiotics are essential to help to enhance the effect of surgical treatment. 5. Gran dual bony regeneraton was shown in a series of radiographs by intevals of a month and clinical symptoms such as trismus, TMJ pain etc. were disappeared from 10 days after operation. 6. It is considered that it is necessary to correct the ugly facial scars by plastic scar revision.