Unusually aggressive osteomyelitis of the jaws. A report of two cases

Rapidly progressing osteomyelitis of the mandible

Acute osteomyelitis exists as a refractory disease even now, which usually exhibits systemic symptoms such as fever or malaise and local redness or swelling. The present paper describes a case of acute osteomyelitis of the mandible that was rapidly progressing without typical symptoms. The patient had liver cirrhosis, which should be one of the systemic factors that affect immune surveillance and metabolism. Actinomycotic druses and filaments were detected from the sequestrum. These were considered to play a role in the rapid progression of osteomyelitis without typical symptoms. There has been no evidence of local recurrence 24 months after surgery.

Chronic recurrent multifocal osteomyelitis involving both jaws: report of a case including magnetic resonance correlation

A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

Maxillary sinus atelectasis

Two patients are presented with maxillary bone loss and atelectasis of the sinus walls in association with chronic subclinical maxillary sinusitis. Maxillary sinus atelectasis results in a mild cosmetic deformity, but may also cause diplopia by involving the orbital floor. Ostial obstruction and inflammation-mediated osteopenia are postulated to be the responsible mechanisms. Surgical treatment of the sinusitis may prevent progression of the bone loss.

Osteomyelitis associated with chronic periodontitis: a report of three cases

Correctly differentiating between periodontal abscess (localized, acute suppurative infection of the periodontium) and osteomyelitis (the extension of an infection into the bone medullary cavity) is crucial since the former may not require antibiotics for resolution, while the latter will. Initial assessment and treatment of osteomyelitis should be based on clinical examination, radiographic interpretation, and experience. Three case histories of osteomyelitis are presented, ranging from a periodontally well-localized case to one involving a hemimandible and crossing the midline. Successful early diagnosis and case management may benefit from scintigraphic interpretation and culture-and-sensitivity studies.