咬筋下隙に隣接した下顎枝外側部骨膜下骨髄炎の1例

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There are two types of pyogenic osteomyelitis of the jaws. One is intramedullary osteomyelitis and the other is subperiosteal osteomyelitis. Subperiosteal osteomyelitis on the outer cortical bone of the mandibular ramus adjacent to the submasseteric space, usually results from pericoronitis. If a submasseteric abscess, which is formed by backward spreading of the pericoronitis, presents itself continuously, the outer cortical bone is involved and osteomyelitis results. We would like to present a case with subperiosteal osteomyelitis of the outer cortical bone of the ramus. The patient, a 43-year-old man, visited our clinic complaining of trismus and swelling of the left cheek on 17 th of March, 1985. Two months before his first visit to us, he had pain in the region of the left lower third molar, swelling of the left cheek and mouth-opening limitation. Although he received extraction of the left lower third molar tooth and administration of antibotics at a dental clinic, he did not improve. Then he visited an ENT and was advised to visit to our clinic. At the first examination by us, clinical findings revelaed diffuse swelling on the left cheek and the left molar gingiva, trismus and pus discharge. The X-rays showed bone distraction of the outer cortex of the ramus. We administered antibiotics intravanously and operated on the patient under general anesthesia. The curettage and sauserization was done intraorally. A drain was inserted and the wound was closed. After the operation, pus discharge, swelling and trismus disappeared and there has been no reccurence. Histopathological examination of the excised and curetted tissue showed formation of active or old granullation tissue and bone necrosis. Adjacent to them, there were chronic inflammatory cell infiltration, proliferation of fibrous tissue and new bone formation. Diagnosis of subperiosteal osteomyelitis adjacent to the submasseteric space was made from its clinical feature and histopathological findings. Its location and radiological findings are characteristic, so it can be said that this case is one of typical subperiosteal osteomyelitis adjacent to the submasseteric space.

咬筋下隙に隣接した下顎枝外側部骨膜下骨髄炎の1例

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