CASE REPORT   

European Journal of Oral and Maxillofacial Surgery 2018 April;2(1):13-7

DOI: 10.23736/S2532-3466.17.00128-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Fluorescence-guided bone debridement in the management of chronic osteomyelitis of jaws

Karoline ARAUJO LIMA ✉, Ruth C. GOMES de SOUZA, Valber BARBOSA MARTINS, Flávio TENDOLO FAYAD, Gustavo CAVALCANTI de ALBUQUERQUE, Marcelo V. OLIVEIRA, Joel MOTTA JUNIOR

Department of Oral and Maxillofacial Surgery, Amazonas State University (UEA), Manaus, Brazil

Osteomyelitis is an inflammatory process that affects the cancellous portion of the affected bone and can progress to the cortical bone, the periosteum and surrounding soft tissue inducing to necrosis. The debridement and/or resection is the treatment of choice for advanced disease states, however, the execution of the surgical technique still has little standardization, due to lack of imaging modalities that allow a precise visualization of the limits of inflammation in the bone tissue, which leads the surgeons to guide themselves only by clinical parameters during surgery, such as bleeding and bone staining. The induced fluorescence tetracycline is a bone marker that has been introduced in the debridement of osteonecrosis as an important tool in intraoperatory to distinguish vital bone from necrotic bone. The aim of this article was to evidence the use and feasibility of tetracycline fluorescence-guided surgical debridement and to demonstrate how this treatment modality can became an important additional intraoperative surgical guide for surgeons. Two patients with mandibular chronic osteomyelitis underwent surgical debridement of the affected areas. After administration of 10 preoperative days of doxycycline, bone fluorescence was monitored intraoperatively with the aid of an ultraviolet light emitting device. Doxycycline was sufficiently incorporated only into the viable bone, which appeared fluorescent, making it possible to distinguish it from necrotic bone. This intraoperatory distinction has helped to identify the debridement extension, allowing a more effective and conservative surgical therapy for chronic osteomyelitis.

KEY WORDS: Fluorescence - Debridement - Tetracycline - Jaw - Osteomyelitis