PMC9283791_01
Preoperative axial CT scan of the neck at the C2 level showing osteomyelitis in region 38 of the mandibular ramus. The affected side shows loss of cortical margin (arrow) and soft tissue swelling.
fsurg-09-867088-g001.jpg
PMC9283791_01_fsurg-09-867088-g001.jpg
F1
CoV-2 virus. CT scan showed lamellar perimandibular purulent collection, cellulitis of soft tissue, and osteomyelitis surrounding the alveolus of the extracted tooth (Figure 1).
PMC9283791_02
Axial CT scan of the neck at the C1 level after the relapse of the infection. (A) 3D reconstruction showing sequestrum of bone with a corrugated drain properly placed above the osteomyelitic site. (B) Cross section of the osteomyelitic mandibular ramus:bone is thin with loss of both medulla and cortex. A reconstructive plate was placed so the mandible could withstand masticatory forces.
fsurg-09-867088-g002.jpg
PMC9283791_02_fsurg-09-867088-g002.jpg
F2
Postoperative scintigraphy showed inflammation of the ramus of the mandible, and CT confirmed sequestrum formation in the ramus (Figure 2).
PMC9283791_03
Coronal MRI of the orbits and sinuses taken on the fourth day after hospital admittance: cellulitis of the left orbit with hyperintense signal in preseptal and postseptal areas. Inflammatory thickening of the mucosal lining of the left frontal sinus, ethmoid cells, and maxillary sinus.
fsurg-09-867088-g003.jpg
PMC9283791_03_fsurg-09-867088-g003.jpg
F3
Repeated CT and MRI scans (Figure 3) showed progression of the inflammation that was treated surgically with debridement of necrotic tissue, irrigation, and iodoform gauze packing.
Reconstruction of the defect. (A) Preoperative planning with modified Weber-Ferguson incision. (B) Exposed necrotic bone. (C) 9-month follow-up. The orbital and facial defect is closed, and maxillary dead space is obliterated with the bulk of the ALT flap. The nasal pyramid is leaning toward the operated side because the bone and cartilage support has been removed. (D) ALT flap lining the palatal defect.
fsurg-09-867088-g004.jpg
PMC9283791_03_fsurg-09-867088-g004.jpg
F4
Instead, he received a microvascular anterolateral tight flap that served to line the orbital, nasal, and palatal defect and separate the nasal cavum from the mouth (Figure 4).