Mandibular Osteitis Revealing Calcium-Phosphate Imbalance in a Severely Disabled Child: A Case Report

Calcium-phosphate metabolism disturbances are common yet often underrecognized in children with severe disabilities. These imbalances can lead to serious bone disorders, including rickets, osteomalacia, and osteomyelitis. We report the case of a 10-year-old girl with cerebral palsy and epilepsy who developed infectious mandibular osteitis, revealing an underlying calciumphosphate imbalance. Clinical and laboratory findings showed hypocalcemia, hypophosphatemia, elevated parathyroid hormone levels, and severe vitamin D deficiency—consistent with secondary rickets. The child had been receiving long-term carbamazepine therapy, a medication known to accelerate vitamin D catabolism. A multidisciplinary evaluation involving pediatric neurology, hematology, anesthesia, and maxillofacial surgery was conducted. Before surgery, metabolic abnormalities were corrected and antibiotic treatment initiated. Anesthetic management was tailored to a high-risk airway scenario, with nasotracheal intubation performed using a Boussignac bougie. The surgical procedure included intraoral curettage and selective tooth extractions, without complications. This case illustrates how chronic antiepileptic therapy, nutritional deficiencies, and physical disability can converge to cause severe metabolic and infectious complications. Successful perioperative management requires early recognition, preoperative stabilization, airway preparedness, and individualized anesthetic strategies. A coordinated multidisciplinary approach was essential for achieving a favorable outcome.