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Postextraction osteomyelitis in a bone marrow transplant recipient

A Barasch1, K M Mosier, J A D'Ambrosio

  • 1Department of Oral Diagnosis, School of Dental Medicine, University of Connecticut Health Center, Farmington.

Oral Surgery, Oral Medicine, and Oral Pathology
|March 1, 1993
PubMed
Summary

Mandibular osteomyelitis can occur after dental extraction in bone marrow transplant (BMT) recipients, even when guidelines are followed. Prompt recognition and treatment are crucial for these immunocompromised patients.

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Area of Science:

  • Oral surgery
  • Hematology
  • Infectious disease

Background:

  • Dental extractions in patients undergoing bone marrow transplantation (BMT) require careful adherence to surgical guidelines.
  • Lymphoblastic lymphoma patients undergoing BMT are at risk for various complications, including infections.

Observation:

  • A patient developed mandibular osteomyelitis 10 days post-dental extraction and BMT, presenting with tenderness, fever, and positive blood cultures for Staphylococcus epidermidis.
  • Radiographic findings confirmed low-grade osteomyelitis, characterized by lamina dura loss and osseous rarefaction near the extraction site.

Findings:

  • Despite following National Cancer Institute guidelines for dental extraction prior to chemotherapy, mandibular osteomyelitis developed in a BMT recipient.
  • Staphylococcus epidermidis bacteremia was identified, with osteomyelitis considered a potential source alongside a presumed Hickman catheter infection.

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Implications:

  • This case highlights the importance of considering mandibular osteomyelitis in febrile BMT recipients with dental extraction history, even with adherence to protocols.
  • Recommendations for dental procedures and prophylactic antibiotics in catheterized BMT patients are discussed to prevent such infections.
  • Early diagnosis and management of osteomyelitis are critical in profoundly immunosuppressed BMT patients to ensure favorable outcomes.