J Korean Assoc Oral Maxillofac Surg.  2015 Dec;41(6):332-337. 10.5125/jkaoms.2015.41.6.332.

Chronic maxillary sinusitis and diabetes related maxillary osteonecrosis: a case report

• Huh S
• Lee CY
• Ohe JY
• Lee JW
• Choi BJ
• Lee BS
• Kwon YD

• KMID: 2133181
• DOI: http://doi.org/10.5125/jkaoms.2015.41.6.332

Abstract

Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment.

Keyword

Maxillary osteomyelitis; Diabetes mellitus; Maxillary sinusitis

MeSH Terms

Anemia
Causality
Diabetes Mellitus
Diabetes Mellitus, Type 2
Female
Humans
Jaw
Maxillary Sinus*
Maxillary Sinusitis*
Osteomyelitis
Osteonecrosis*

Figure

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  Fig. 1 Radiographic exams at the first visit show relatively well defined bone destructive lesion (sequestrum) on right maxillary molar area with elevation of sinus floor. A. Panoramic radiograph. B, C. Cone-beam computed tomography.

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  Fig. 2 Intra-oral photographs show oro-antral fistula (palate; A) and bony exposure (buccal; B) on left maxilla after 14 months since the first visit.

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  Fig. 3 Radiographic exams show severe bony destructive lesions on both maxilla and mucosal thickening on both maxillary sinuses after 14 months since the first visit. A. Panoramic radiograph. B, C. Cone-beam computed tomography.

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  Fig. 4 Bone scan; active bony lesions in both maxilla.

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  Fig. 5 Clinical photographs were taken during operation (A) extensive necrotic destruction of the both maxilla (B) excised specimen of left maxilla and palate (C) reconstruction with buccal fat pad flap (D) primary wound closure.

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  Fig. 6 Histopathologically, bony tissues show bony necrosis, marrow fibrosis and numerous sulfur granules with acute and chronic inflammatory cell infiltration (H&E staining, ×200).

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  Fig. 7 Postoperative radiographic exams. A. Panoramic radiograph. B, C. Cone-beam computed tomography.

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  Fig. 8 A. Intra-oral photographic with removable partial denture. B. No signs of recurrence after 13 months of follow-up.

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