HEMATOGENOUS OSTEOMYELITIS OF THE HAND SKELETON IN ADULTS AFTER DENTAL MAXILLARY INFECTIONS

Hematogenous osteomyelitis is infrequently seen in adults and primary involvement of the hand skeleton is extremely rare. Little has been re ported about the foci of hematogenously spread infections. Two cases o f hematogenous osteomyelitis of the hand originating from dental maxil lary infections are reported, The first patient suffered an acute hema togenous osteomyelitis of the wrist joint, spreading from dental granu lomas and massive periodontitis, Despite early radical debridement, at tempts to salvage the wrist joint and the extensor tendons failed, so that a wrist fusion had to be performed. The functional outcome was po or, The second patient demonstrated a chronic hematogenous osteomyelit is of the fourth and fifth metacarpals originating from chronic maxill ary sinusitis. Radical debridement and use of ''spare parts'' of the f ifth metacarpal prevented an amputation of the fourth ray, The functio nal outcome was excellent, These cases emphasize the importance of inc luding an examination of the dental maxillary area when searching for a primary focus of hematogenous osteomyelitis.