Acute Osteomyelitis of the Maxilla in a Newborn

Report of case History.-E. R., a white male aged 15 days, was admitted to the New Haven Hospital on Dec. 28, 1944, with fever and facial swelling. Some discoloration and edema of the left side of the face were noticed immediately following his birth in a neighboring hospital. These subsided within 24 hours. The baby was discharged home at one week of age in apparently good health. On the ninth day of life swelling and redness of the left side of the face were noted and the family physician advised hot applications. The following day there was a purulent sanguineous discharge from the left nostril and from sinus tracts along the labial sulcus and the hard palate of the involved side. The infant had fever to 101°F. His general condition remained good and he took feedings well. On the fourth day of illness (thirteenth day of life) the baby was definitely worse. The discharge from the left nostril and fistulae was more profuse and the edema and redness of the left half of the face more pronounced. Sulfathiazole was administered in an initial amount of three grains with one and one-half grains every four hours thereafter. However, the signs and symptoms progressed during the next two days and he was admitted to the New Haven Hospital. Examination.-At the time of the infant's admission his temperature was 102 'F. He was well developed and nourished (4400 grams) and was acutely but not critically ill. Respirations were rapid and grunting in character. The entire left side of the face was red and markedly swollen. The nose was deviated to the right. A thick purulent discharge was oozing from the left nostril. The alveolar ridge was edematous and there were sinus tracts in the left gingivolabial sulcus and alveolar ridge. Considerable swelling of the hard palate on this side with a perforation was present. Pressure over the maxilla caused an increase in purulent discharge from the nostril and the three sinus tracts. The left eye was chemotic but not proptosed. There was no cervical adenopathy.