Management of a Partially Treated Case of Chronic Osteomyelitis of the Hard Palate and Maxillary Sinus

TL;DR

This case report describes the treatment of a 45-year-old man with chronic osteomyelitis affecting his palate and maxillary sinus, managed through surgery and antibiotics.

Contribution

The paper presents a clinical case highlighting the management approach for a partially treated chronic osteomyelitis case involving the hard palate and maxillary sinus.

Findings

Surgical debridement and antibiotic treatment were effective in managing chronic osteomyelitis in a diabetic patient.

Histopathological analysis confirmed the diagnosis of maxillary osteomyelitis following sinus and palatal procedures.

The patient presented with symptoms including palatal ulcer, halitosis, and speech difficulty, linked to underlying diabetes.

Abstract

Osteomyelitis affects bones, including both cortex and medulla. It influences the mandible more frequently than the maxilla. Probable etiologic factors include foci of infection or trauma; however, the hematogenous spread of infection from a distant site is also a causative factor. Staphylococcus is the common organism involved in the causation. Clinical symptoms include signs of inflammation, pus drainage, fistulous or sinus tracts, wound disintegration, erythema, and raised local temperatures. Laboratory diagnosis with the evaluation of white blood cell count, rate of erythrocyte sedimentation, and C-reactive protein proves vitally significant. Radiographic evaluation reveals sequestra and bone destruction in the affected region. Histopathology of the lesion is confirmatory for the final diagnosis, which helps in the formulation of an appropriate management strategy. The treatment regimen usually focuses on thorough debridement of the necrotic material and an antibiotic regimen. This case report describes a male patient aged 45 years presenting with a palatal ulcer, severe halitosis, and speech difficulty. He has suffered from type II diabetes mellitus for four years. A radiological examination was carried out. Treatment was performed with surgical debridement of necrotic maxillary bone and curettage of bilateral maxillary and ethmoid sinuses under general anesthesia. Results of histopathological evaluation of the curetted material from the maxillary and ethmoid sinuses revealed osteomyelitis of the maxilla.

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