Osteomyelitis of the maxilla in infancy.

OSTEOMYELITIS of the maxilla in infants is a rare but well-recognized clinical entity. Asherson (1939) collected 42 cases from the literature and reviewed the condition in detail. He stated that the mortality was 25 per cent. and remarked upon the frequency of such sequelae as cicatricial ectropion and sequestrum formation which require plastic surgery. He also emphasized the frequency with which relapses occur. The condition commonly occurs in the first 12 weeks of life and usually follows an infection of the first deciduous molar tooth bud (Wilensky, 1932). Other sites from which the infection may arise are the maxillary antrum or lacrimal sac (Haworth, 1947). The cheek and orbital tissues of the affected side rapidly swell causing chemosis and later proptosis and ophthalmoplegia. The hard palate on the affected side is inflamed and swollen, and one or more sinuses may be seen. There may also be a secondary acute dacryocystitis. The infant is febrile and may have diarrhoea. Its general condition deteriorates rapidly. Orbital cellulitis may be the diagnosis first suggested (Magnus, 1944) and these patients are likely to be referred to an eye department. This happened in two of the four cases seen by us. Orbital cellulitis, however, almost never appears in the first few months of life. It is associated with sinusitis and mucopus in the nostril of the same side. The site of maximum swelling and tenderness is at the margin of the orbit above the medial palpebral ligament. The hard palate is not involved. In primary acute dacryocystitis the site of maximum swelling and tenderness is over the sac just below the medial palpebral ligament. The roof of the mouth is not involved and the infant is not seriously ill.