Chronic osteomyelitis secondary to an infected tusk can be very destructive as it spreads through the mandible and surrounding soft tissue structures. The extension of the disease can lead to complete loss of mandibular structure and bone. The infection may cause severe periodontal disease of the overlying premolars and molars. The disease and bone loss may become so devastating that permanent oral cutaneous fistulas develop. The disease may also spread into the medial cortex of the mandible creating complete bone loss leaving only a fibrous capsule of the mandible with a draining cutaneous fistula. A combination of xenograft and platelet rich fibrin shows great potential for management of the destructive osteomyelitis commonly associated with a chronically infected tusk.

Bone graft/Xenograft
There are several types of xenograft material commercially available. Most sources use bone from cattle and process it so that it can be used in other species (including humans).

Platelet Rich Fibrin (Leukocyte Rich)
Platelet Rich Fibrin (PRF) can be produced as a liquid or solid form. The solid form is most commonly used in cases with osteomyelitis. There are two types of solid form that may be created based on centrifuge speed (rpm), force (g) and time (min). The original form (L PRF) is collected in glass blood tubes. The centrifuge is set at 708 g, 2700 rpm for 12 min. The current solid form used in human maxilla facial surgery is the A-PRF which is made by collecting blood in plastic tubes and setting the centrifuge at 1500 rpm, with a “g” force of 208 for 14 minutes. This form of PRF has the highest proportion of leukocytes which is helpful when placed in an infected environment. Recently an injectable or liquid version of PRF (I PRF) has been developed. It is created by setting the centrifuge at 60 g, 3300 rpm for 2 min. When the fibrin clot is compressed to remove the liquid, a membrane remains that can be used as a matrix barrier. This barrier slows invading epithelial cells and has a slow release of growth factors to enhance osteoblast activity.