Mandibular infarction and sterile subperiosteal fluid collection in patients with sickle cell disease: a report of two cases.

BACKGROUND: Vaso-occlusive crisis (VOC) is the primary cause of morbidity and emergency department visits in patients with sickle cell disease (SCD) and may lead to acute bone infarction. Infarction most commonly affects the long bones; however, the craniofacial bones may also be involved. AIM/OBJECTIVES: The purpose of this case series was to describe the initial diagnosis and management of acute infarction of the mandible in the setting of sickle cell VOC. MATERIALS AND METHODS: This case series included two patients with SCD who developed VOC and acute mandibular infarction with associated subperiosteal fluid collections. Clinical presentation, laboratory findings, imaging findings, management, and follow-up were described. RESULTS: Both patients presented with pain, trismus, fever, leukocytosis, elevated inflammatory markers, and imaging demonstrating subperiosteal fluid collections adjacent to the site of mandibular infarction. One patient underwent operative incision and drainage. Cultures demonstrated contaminating skin flora without pathogenic growth, favoring a sterile inflammatory process. The other patient had complete resolution of symptoms with supportive management and no surgical intervention. Both patients remained asymptomatic at follow-up. CONCLUSION: Acute mandibular infarction is a rare manifestation of sickle cell VOC and may closely mimic an infectious process. However, fluid collections associated with bone infarction are frequently sterile. Both operative and non-operative management strategies may result in symptom resolution, and the decision to surgically intervene should be determined on an individualized basis.