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Rusty green stained temporal bone associated with exposure to tetracycline: an unusual presentation of black bone disease.

J Laryngol Otol

March 2015

Department of Head and Neck Surgery,David Geffen School of Medicine at UCLA, University of California,Los Angeles,USA.

Objective: To review the phenomenon and implications of temporal bone and craniofacial bone staining in the context of prolonged exposure to tetracycline antibiotic.

Methods: Case report and literature review.

Results: A 52-year-old male with a 5-year history of tetracycline use presented to undergo tympanomastoidectomy and was found to have an unusual rusty green pigmentation of the entire aspect of the exposed temporal bone.

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Lesions were created in the incisor enamel organs of adult rats by a single dose of tetracycline, and the secretory products in these lesions were examined with the transmission electron microscope. The following abnormal products were found: 1) circumscribed areas of a mottled uncalcified material within the enamel; 2) an uncalcified material consisting of tubules with dimensions similar to the crystal coat of normal enamel, 3) spherical calcified masses which at their periphery resemble normal enamel; 4) layers of a basal lamina-like material in the extracellular spaces between Tomes' processes, and an attachment site-like modification of the cell borders next to this material. It is suggested a) that the enamel tubule is a primary secretory product of the ameloblast; in normal enamel it would support the growth of the crystal; b) that, in the lesion, enamel can grow by diffusion of precursors from distant ameloblasts, while rat enamel normally grows only in direct contact with the ameloblast cell membrane.

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The present study was done in order to examine the durability of the tetracycline-induced antimicrobial capacity, and also to assess the reproducibility of the bacterial growth-inhibitory assay used. Standardized enamel and dentin specimens were impregnated in aqueous solutions of tetracycline HCl, oxytetracycline HCl or doxycycline HCl, rinsed in water, and stored dry for 200 days. Another series of specimens was impregnated in solutions of doxycycline HCl and then rinsed in tap water for varying periods up to 35 days.

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