PMC9400918_01
Intraoral picture shows swelling of the gingiva in the right maxillary molar area with fistula.
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F1
Intraoral examination revealed multiple missing permanent teeth (teeth 14, 16, 26, 37, and 47), swelling of the gingiva at teeth 14 and 16 with fistula, and overflow of pus when pressing (Figure 1).
Radiograph (A, B) shows multiple teethmissing (teeth 14, 16, 26, 37,and 47) and osteonecrosis areas appear in the posterior part of the right maxilla. (A, C) The posterior part of the right maxilla presents a patchy bone destruction area with an unclear boundary. The cortical bone in the lesion area is discontinuous. The bone density of the lesion area is slightly higher than that of the contralateral bone, indicating sequestrum.
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F2
The bone density of the lesion area is slightly higher than that of the contralateral bone (Figure 2).
(A) Infiltration of plasma cells, lymphocytes, and neutrophils can be seen in fibrous connective tissue [hematoxylin and eosin (H&E), original magnification x10]. (B) A large number of trabecular bone structures, sequestrum structures, reduced number of osteocytes, and empty lacunae (arrow) can be seen in some areas, which are signs of osteomyelitis (H&E, original magnification x40).
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F3
As shown in Figure 3, there are some empty lacunae in the trabecular bone and a large number of lymphocytes and plasma cells in some areas, which are signs of osteonecrosis.
One week after surgery, the patient's incision recovered well, with no swelling and oozing and no signs of infection.
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F4
One week later, the patient's wound was healing well with no signs of infection (Figure 4).