안와에 발생한 만성골수염 1예
A Case of Chronic Osteomyelitis of the Orbit
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목적: 안와에 발생한 만성골수염 1예를 경험하였기에 이를 국내에서 최초로 보고하고자 한다. 증례요약: 61세 여자 환자가 약 3개월 전부터 시작한 우측 안구 주위 부종 및 통증을 주소로 내원하였다. 과거력상 3개월 전 치주염으로 치료받은 기왕력이 있었다. 이학적 검사에서 우측 하안검에서 안와하벽까지 깊게 위치한 부종과 압통을 동반한 경성 종물이 촉지되었으며, 그 외 안구에 특이소견은 보이지 않았다. 안와전산화단층촬영 및 골 스캔에서 안와 하벽과 외벽을 포함한 상악골 및 관골에만성골수염 및 연부조직염 소견이 보였고, 전신적 항생제요법을 시행하였다. 내원 7일째 연부조직염은 호전되었으나, 경성 종물의크기는 변하지 않아 절개 배농술 및 괴사조직의 변연절제술을 시행 후 배양검사 및 조직검사를 시행하였다. 조직검사결과 만성 육아종성 염증과 골괴사 소견을 보였고, 경험적 항생제 치료를 지속하였다. 추적 관찰 6개월까지 우측 안와 주변 병변은 소실된 상태로재발 및 이상소견은 보이지 않았다. 결론: 안와에 발생한 만성골수염에 대해 항생제 주사치료와 절개 배농술로 좋은 치료 결과를 얻을 수 있었다.
Abstract
Purpose: To report a case of chronic osteomyelitis of the orbit. Case summary: A 61-year-old woman visited the ophthalmology clinic with a 3-month history of right periorbital swelling andpain. She had a history of ondontitis treated with oral antibiotics three months previously. A hard, tender, swollen mass was palpatednear the right lower eyelid extending to the floor of the right orbit. Otherwise, there were no other clinically-specific ocularsigns. Orbital computed tomography and bone scan findings suggested right periorbital soft tissue inflammation with underlyingosteomyelitis of maxillar and zygomatic bones involving the inferior and lateral orbital walls. The patient was admitted and treatedwith broad spectrum systemic antibiotics. After 7 days, periorbital soft tissue swelling and pain were improved, but the size ofthe hard mass was unchanged. Seven days after admission, incision and drainage of the periorbital hard mass near the lowereyelid and debridement of the necrotic and pyogenic tissue were performed. Histologic examination showed chronic granulomatousinflammation and bony necrosis of the mass. The patient was discharged after receiving systemic antibiotics for 7more days. At the 6-month follow-up, no recurrence or abnormal findings in the right periorbital region were observed. Conclusions: Chronic orbital osteomyelitis should be treated with combined systemic antibiotics and surgical intervention.
참고문헌 (20)
- Koorbusch GF, "Retrospective assessment of osteomyelitis. Etiology, demographics, risk factors, and management in 35 cases", Oral Surgery, Oral Medicine, Oral Pathology, 74, pp.149~154 (1992)
- Pincus DJ, "Osteomyelitis of the craniofacial skeleton", Seminars in Plastic Surgery, 23, pp.73~79 (2009)
- Kapoor S, "Osteomyelitis of orbital bones", J Pediatr Ophthalmol, 14, pp.171~175 (1977)
- el-Toukhy E, "Osteomyelitis of the orbit", Ophthal Plast Reconstr Surg, 13, pp.68~71 (1997)
- Sethi A, "Tubercular and chronic pyogenic osteomyelitis of cranio-facial bones: a retrospective analysis", J Laryngol Otol, 122, pp.799~804 (2008)
- Prasad KC, "Osteomyelitis in the head and neck", Acta Otolaryngol, 127, pp.194~205 (2007)
- Chang PC, "Central skull base osteomyelitis in patients without otitis externa: imaging findings", AJNR Am J Neuroradiol, 24, pp.1310~1316 (2003)
- Kim SG, "Treatment of chronic osteomyelitis in Korea", Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 92, pp.394~398 (2001)
- Arunkumar JS, "Role of nasal endoscopy in chronic osteomyelitis of maxilla and zygoma: a case report", Case Reports in Medicine, 2011, pp.802964~ (2011)
- Kosaka Y, "Idiopathic osteomyelitis of the zygoma", Plast Reconstr Surg, 97, pp.1305~1306 (1996)
- Hudson JW, "Osteomyelitis of the jaws: a 50-year perspective", J Oral Maxillofac Surg, 51, pp.1294~1301 (1993)
- Peravali RK, "Osteomyelitis of maxilla in poorly controlled diabetics in a rural Indian population", J Oral Maxillofac Surg, 11, pp.57~66 (2012)
- Das JC, "Tuberculous osteomyelitis and optic neuritis", Ophthalmic Surgery, Lasers and Imaging, 34, pp.409~412 (2003)
- O'Doherty M, "Voriconazole in the treatment of fungal osteomyelitis of the orbit in the immunocompromised host", Orbit, 24, pp.285~289 (2005)
- Spoor TC, "Orbital tuberculosis", Am J Ophthalmol, 91, pp.644~647 (1981)
- Baker AS, "Role of anaerobic bacteria in sinusitis and its complications", Ann Otol Rhinol Laryngol Suppl, 154, pp.17~22 (1991)
- Bamberger DM, "Osteomyelitis. A commonsense approach to antibiotic and surgical treatment", Postgrad Med, 94, pp.177~184 (1993)
- Mader JT, "Antimicrobial treatment of chronic osteomyelitis", Clin Orthop, 360, pp.47~65 (1999)
- Yeoh SC, "Chronic suppurative osteomyelitis of the mandible: case report", Australian Dental Journal, 50, pp.200~203 (2005)
- Goldberg AN, "Complications of frontal sinusitis and their management", Otolaryngol Clin North Am, 34, pp.211~225 (2001)