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Exogenous Estrogen May Exacerbate Thrombophilia, Impair Bone Healing and Contribute to Development of Chronic Facial Pain

1998; Taylor & Francis; Volume: 16; Issue: 3 Linguagem: Inglês

10.1080/08869634.1998.11746052

2151-0903

Charles J. Glueck, Robert E. McMahon, Jerry E. Bouquot, Douglas A. Triplett,

Protease and Inhibitor Mechanisms

ABSTRACTA 32 year old white female, in apparently good health, failed to respond to conservative wound care for alveolar osteitis after a routine mandibular first molar extraction. Curettage and biopsy of necrotic alveolar bone from the #30 socket escalated her pain such that hospitalization was necessary for pain management with intravenous morphine. Twelve months prior to admission she had been placed on exogenous estrogen (Premarin, 0.625 mg/day) after partial oophorectomy. While hospitalized, she was found to have resistance to activated protein C (APCR). Premarin was discontinued. After discharge, weekly changes of an antibiotic impregnated dressing allowed for progressive regeneration of bone and epithelium with gradual reduction in her pain. She was found to be heterozygous for the mutant Factor V Leiden, a heritable factor for increased tendency to form thrombi, so-called thrombophilia. We speculate that the exogenous estrogen administration exacerbated the thrombophilia associated with the Factor V Leiden mutation by compounding the patient's resistance to activated protein C thereby contributing to her development of osteonecrosis and severe alveolar neuralgia. Additional informationNotes on contributorsCharles J. GlueckDr. Charles A. Glueck received his medical degree from Western Reserve University in 1964 after graduating from Harvard University. Upon completion of his internship and residency training in internal medicine at Massachusetts General Hospital, Dr. Glueck joined the staff of the Molecular Disease Branch of the National Heart, Lung and Blood Institute at the National Institutes of Health (1966–1969). He has authored over 400 scientific manuscripts and is considered a world authority on the role lipids play in the pathogenesis of atherosclerosis in various organ systems. Currently, Dr. Glueck is the Medical Director of The Cholesterol Center at Jewish Hospital, one of the teaching hospitals associated with the University of Cincinnati Medical Center.Robert E. McMahonDr. Robert E. McMahon graduated from Northwestern University Dental School in Chicago in 1969 and served his residency in oral and maxillofacial surgery, University of Chicago and the Pritzker School of Medicine from 1964 to 1972. He is certified by the American Board of Oral and Maxillofacial Surgery and has authored numerous scientific article. He has special interests in temporomandibular joint (TMJ) disorders and atypical facial neuralgias. Dr. McMahon has been Clinical Investigator at Indiana University Medical School since 1989 for the Residual Infection in Bone (RIIB) project and consultant to the NICO project (Neuralgia-Inducing Cavitational Osteonecrosis) at Jewish Hospital in Cincinnati, Ohio.Jerry E. BouquotDr. Jerry Bouquot received his D.D.S. and M.S. degrees from the University of Minnesota, with post doctoral fellowships to the Mayo Clinic and the Royal Dental College in Copenhagen, Denmark as the receipient of a Career Development Award from the American Cancer Society. He was on the faculty of West Virginia University for 20 years, 17 years as Chairman of the Department of Oral & Maxillofacial Pathology. Currently, Dr. Bouquot is the Director of Reasearch for the Maxillofacial Center for Diagnostics and Research in Morgantown, West Virginia. He also serves as Director of Head & Neck Diagnostics of America, a national biopsy service with contributors from 44 states and Canada.Douglas TriplettDr. Douglas A. Triplett is the Director and Vice President of Ball Memorial Hospital and Assistant Dean/Professor of Pathology, Indiana University School of Medicine. He is a graduate of Indiana University School of Medicine. He has been Director of the Hematology Section of Ball Memorial Hospital from 1974 to 1997. Currently, he is Director Midwest Hemostasis and Thrombosis Laboratories. He is Board-certified in anatomic and clinical pathology, hematology and transfusion medicine. His national activities include past membership on the Council on Thrombosis for the American Heart Association; Chair, College of American Pathologists Coagulation Resource Committee (1980–1992; currently an Advisor); Editor American Society of Clinical Pathologists Check Sample series on Thrombosis and Hemostasis; and member of Organizational Committee for Anticoagulant Forum. Currently, he is Associate Editor of "Thrombosis Research" and on the Editorial Boards for Thrombosis and Hemostasis, American Journal of Clinical Pathology, Hematopathology and Molecular Hematology, and Hemostasis. Dr. Triplett has also served as Chair of the Scientific Standardization Committee/International Society Thrombosis an Haemostasis Subcommittee on Lupus Anticoagulants/Phospholipid-dependent Antibodies (1992–1996). He has published over 100 articles on hemostasis and thrombosis as well as written the book, "Hemostasis: A Case-oriented Approach."