Garre's Osteomyelitis of the Jaw-A Case Report

顎骨之蓋銳氏骨炎－病例報告

呂明怡(Ming-Yi Lu) ； 彭芷瑜(Chih-Yu Peng) ； 曹登富(Teng-Fu Tsao) ； 余權航(Chuan-Hang Yu)

《臺灣口腔顎面外科學會雜誌》 26卷3期 (2015/09) Pp. 221-227

摘要

蓋銳氏骨炎常見於齒源性感染所引發，好發於年輕人的下顎。處理方式包括移除感染源以及投與抗生素治療。本病例報告為發生於十四歲男性患者下顎骨之蓋銳氏骨炎。患者在六週前發現在左側臉頰處逐漸腫大且伴隨疼痛。口外檢查發現臉頰左右兩側不對稱，左側臉頰在下顎骨邊緣處有腫大的現象並有癢管形成。口內檢查發現在下顎左犬齒及第一小臼齒處有癢管產生，並且有輕微的骨擴張，但無明顯的疼痛、觸痛及局部發熱現象。環口攝影顯示在下顎第一小臼齒為開放根尖，並有放射線透射之病變。腫脹部位的下顎骨在下顎咬合片影像中顯示出典型的「洋蔥皮」樣影像。追蹤癢管的來源發現其來自於下顎左側第一小臼齒，此牙有正中咬頭的存在。我們給予患者一個月的低劑量口服抗生素，並且對下顎左側第一小臼齒進行根管治療。患者於治療後，症狀逐漸改善，下顎骨發炎情況逐漸復原，臉頰也回復正常。患者在治療後一年，病變無復發的跡象。

關鍵字

蓋銳氏骨炎 ； 頭頸部

並列摘要

Garr's osteomyelitis usually affects the mandible of young patients secondary to dental infection. Management involves removal of the source of infection and antibiotic treatment. We present a case of Garr's osteomyelitis affecting the mandible of a 14year- old patient. He found a progressive swelling with pain over left lower cheek since 6 weeks ago. Extraoral examination revealed facial asymmetry with swelling over left lower cheek near inferior border of mandible body and a pustule over left facial skin near mandibular angle area. Intraoral examination showed two fistulae at buccal gingiva of teeth #33 and #34, mild bony expansion over left lower vestibule without pain, tender or local heat. The panoramic radiograph showed a radiolucent lesion over apical area of tooth #34 with immature apex. The occlusal radiograph demonstrated a typical ＂onion skin＂ appearance of the affected site. Tracing of the skin fistula revealed the infection was originated from tooth #34, a tooth with central cusp. Low-dose oral antibiotics were empirically given for 1 month and endodontic treatment of the tooth was also performed by an endodontist. After treatment, the symptoms and signs subsided gradually, and spontaneous regeneration and remodeling of bone with normal facial appearance were noted. There is no recurrence of the lesion and patient was well 1 year after treatment.

並列關鍵字

Garr's osteomyelitis ； Head and neck