Mandibular Osteonecrosis and Ramsay Hunt Syndrome Following a Case of Herpes Zoster Travis Rudd, DDS, Bryan Y. Chai, DDS, PhD, Raffi Gurunluoglu, MD,

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Presentation transcript:

Mandibular Osteonecrosis and Ramsay Hunt Syndrome Following a Case of Herpes Zoster Travis Rudd, DDS, Bryan Y. Chai, DDS, PhD, Raffi Gurunluoglu, MD, PhD, Mark Glasgow, DDS Journal of Oral and Maxillofacial Surgery Volume 72, Issue 10, Pages 1974.e1-1974.e6 (October 2014) DOI: 10.1016/j.joms.2014.05.004 Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 1 Initial presentation in December 2007 to the Denver Health Oral and Maxillofacial Surgery Clinic with herpes zoster along the right face in the areas of innervation of the mandibular branch of the trigeminal nerve. The extent of the herpes zoster can be seen from the A, profile and B, front views. B, Right-side Bell palsy also can be seen with the drooping of the lips and C, osteonecrosis of the right mandible with exfoliation of teeth 25 to 29. Journal of Oral and Maxillofacial Surgery 2014 72, 1974.e1-1974.e6DOI: (10.1016/j.joms.2014.05.004) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 2 Radiographic presentation of osteonecrosis of the right mandible. A, Panoramic radiograph and B, computed tomogram show exfoliation of teeth 25 to 29 and 31 with extensive osteonecrosis throughout the right mandible. Osteonecrosis can be seen extending from the midline to the distal side of tooth 32. Journal of Oral and Maxillofacial Surgery 2014 72, 1974.e1-1974.e6DOI: (10.1016/j.joms.2014.05.004) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 3 One-week follow-up after initial debridement of necrotic bone in December 2008. A, The patient had been on antivirals for longer than 1 week, resulting in alleviation of the herpes zoster. B, The surgical site of the initial debridement showed insufficient healing with the presence of more necrotic bone. The site was debrided a second time under local anesthesia. Journal of Oral and Maxillofacial Surgery 2014 72, 1974.e1-1974.e6DOI: (10.1016/j.joms.2014.05.004) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 4 Radiographic presentation of osteonecrosis of the right mandible after debridement in February 2008. A, The panoramic radiograph shows the extent of the debridement. B, Computed tomogram shows postsurgical improvement of the right mandibular quadrant. Journal of Oral and Maxillofacial Surgery 2014 72, 1974.e1-1974.e6DOI: (10.1016/j.joms.2014.05.004) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 5 Evaluation in May 2008 after aggressive surgical debridement in the operating room. A, Profile and B, frontal images show nearly complete resolution of the herpes zoster, with significant scarring at the healed areas. C, Right mandibular osteonecrosis was nearly healed after aggressive surgical debridement. Necrotic bone persisted in the area of dehiscence, necessitating another local debridement. Journal of Oral and Maxillofacial Surgery 2014 72, 1974.e1-1974.e6DOI: (10.1016/j.joms.2014.05.004) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions