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Muraoka H, Kaneda T, Hirahara N, Ito K, Okada S, Kondo T. Diagnostic Efficacy of Diffusion-weighted Imaging in Distinguishing Chronic Diffuse Sclerosing Osteomyelitis from Suppurative Osteomyelitis of the Mandible. Magn Reson Med Sci 2023; 22:283-288. [PMID: 35283395 PMCID: PMC10449550 DOI: 10.2463/mrms.mp.2021-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/22/2022] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Chronic diffuse sclerosing osteomyelitis (CDSO) is a non-suppurative inflammatory bone disease diagnosed based on combined clinical, histopathological, and radiological findings. Accurate diagnosis is important since CDSO is more refractory to treatment than suppurative osteomyelitis. The purpose of this study was to determine the diagnostic efficacy of diffusion-weighted imaging (DWI) in the quantitative assessment of CDSO to distinguish it from acute suppurative osteomyelitis (ASO) and chronic suppurative osteomyelitis (CSO) of the mandible. METHODS Using a retrospective cohort study design, we analyzed MRI data of 6 patients with CDSO and 34 patients with ASO and CSO. The mean apparent diffusion coefficient (ADC) values of the three groups (CDSO, ASO, and CSO groups) were calculated, and differences were analyzed using Kruskal-Wallis and post-hoc Mann-Whitney tests with Bonferroni adjustments. We performed a receiver operating characteristic (ROC) curve analysis to evaluate the ability of the ADC to predict CDSO. P < 0.05 was considered statistically significant. RESULTS The mean ADCs in the CDSO, ASO, and CSO groups were 1.22 ± 0.04 × 10-3 mm2/s, 1.28 ± 0.08 × 10-3 mm2/s, and 1.06 ± 0.09 × 10-3 mm2/s, respectively. Significant differences were observed between the ASO and CSO groups (P < 0.001) and CSO and CDSO groups (P < 0.01). However, there was no significant difference between the ASO and CDSO groups (P = 0.21). The ROC analysis revealed a cut-off ADC value of 1.19 for distinguishing the CSO group from the CDSO group. Sensitivity, specificity, accuracy, and area under the ROC curve were 1.0, 0.92, 0, 95, and 0.94, respectively. CONCLUSION The results suggest that ADC may be useful in distinguishing CDSO from mandibular suppurative osteomyelitis.
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Affiliation(s)
- Hirotaka Muraoka
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takashi Kaneda
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Naohisa Hirahara
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Kotaro Ito
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Shunya Okada
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takumi Kondo
- Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
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Waldman S, Shimonov M, Yang N, Spielman D, Godfrey KJ, Dean KE, Phillips CD, Helman SN. Benign bony tumors of the paranasal sinuses, orbit, and skull base. Am J Otolaryngol 2022; 43:103404. [PMID: 35246319 DOI: 10.1016/j.amjoto.2022.103404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
Abstract
Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.
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Affiliation(s)
- Spencer Waldman
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Menachem Shimonov
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Nathan Yang
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Daniel Spielman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Kyle J Godfrey
- Weill Cornell Medical College, Department of Ophthalmology--1305 York Ave, 12(th) Floor New York, NY 10021, United States of America.
| | - Kathryn E Dean
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - C Douglas Phillips
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - Samuel Nathaniel Helman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
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Long-Term Follow-Up of SAPHO Syndrome for 15 Years Led to a Diagnosis of Temporomandibular Joint Pain and Trismus. Case Rep Dent 2021; 2021:3102037. [PMID: 34868689 PMCID: PMC8642013 DOI: 10.1155/2021/3102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a systemic disease with symptoms of pustular skin disease and sterile osteoarticular lesions. This disease rarely involves the temporomandibular joint (TMJ). Although it is a disease with a good long-term prognosis, its treatment remains challenging. We describe a case with long-term follow-up of SAPHO syndrome for 15 years in which TMJ pain and trismus led to the diagnosis. A 30-year-old woman with TMJ pain and trismus was referred to our department. Her medical history included palmoplantar pustulosis. Sterile inflammation in the left TMJ and diffuse sclerosing osteomyelitis of the mandible were observed. Thus, she was diagnosed with SAPHO syndrome. The symptoms of severe TMJ pain, trismus, and left cheek swelling presented three times in the 15 years. Symptomatic treatment with nonsteroidal anti-inflammatory drugs, antibiotics, corticosteroids, and bisphosphonates was administered several times. There has been no relapse of symptoms over the past nine years. The patient must be continuously kept under observation to look for the relapse of symptoms.
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Wang M, Li Y, Cao Y, Lu X, Liu Y, Zhao J, Zhang W, Li C. Mandibular involvement in SAPHO syndrome: a retrospective study. Orphanet J Rare Dis 2020; 15:312. [PMID: 33153463 PMCID: PMC7643311 DOI: 10.1186/s13023-020-01589-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mandible osteomyelitis can occur in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare chronic inflammatory disease; however, few studies have explored its characteristics and management. METHODS We reviewed the medical records of consecutive SAPHO patients with mandible involvement diagnosed in Peking Union Medical College Hospital from September 2014 to July 2019. Demographic, clinical, laboratory, and imaging data were collected at baseline. Prescription data and follow-up magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) images were collected from the hospital information system. An electronic questionnaire was distributed to all patients to obtain their latest symptoms. RESULTS A total of 26 SAPHO patients with mandibular involvement were involved, all of whom responded to the questionnaire (38.5% male; median age, 28 years; median follow-up duration, 2.1 years). Ten patients (38.5%) had undergone an oral procedure 1 month before the onset of mandibular symptoms. All 14 of the patients who underwent a surgical intervention relapsed within a median duration of 2 months (range 0.25-4.0 months), and 24 patients (92.3%) achieved improvement with conservative treatment. Following bisphosphonate treatment, remission of bone marrow oedema and osteolysis was observed on MRI and CBCT, and 5 patients receiving bisphosphonates with follow-up CBCT after remission did not relapse in 5.4 months (mean 6.0, range 3.2-9.9 months). CONCLUSION Mandibular involvement of SAPHO syndrome predominantly occurs in young women. Dental procedures are a possible risk factor. Conservative treatment, especially intravenous bisphosphonates, can lead to oral improvement.
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Affiliation(s)
- Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yueting Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinyu Lu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuchen Liu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Ferreira-Vilaca C, Costa Mendes L, Campana SC, Bailleul-Forestier I, Audouin-Pajot C, Esclassan R, Canceill T. Orofacial manifestations of SAPHO syndrome: a systematic review of case reports. Clin Rheumatol 2020; 39:3277-3286. [PMID: 32388746 DOI: 10.1007/s10067-020-05084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a poorly known disease with cutaneous and osteo-articular manifestations requiring a multidisciplinary care. The aim of this study was to review the case reports that have described oral manifestations in patients suffering for this syndrome. A systematic review of case reports was performed on PubMed and Science Direct on January 2020 among all the articles dealing with the disease. In vitro, preclinical, and clinical studies have not been included to select only the case reports. Eighteen articles, published between 1999 and 2019, were included. All the patients presented mandibular osteomyelitis or sclerosis, associated with various other symptoms such as trismus, temporomandibular joint arthritis, or dysphagia. The data highlight the high variability in the disease's manifestations between people and also in the treatments applied. Knowing the orofacial signs of the SAPHO syndrome, the dental surgeon has a crucial role in the diagnosis procedure and must take place in the multidisciplinary medical team involved in the patient following. Some care adaptations are needed for oral interventions in these patients, depending on their treatments and their handicap. Key Points • Orofacial manifestations of SAPHO syndrome mainly occur on the mandible. • In cases of mandible sclerosis, decorticalization surgeries may be performed. • Oral care are encouraged, especially the preventive treatments to limit the necessity of surgeries. • The complexity in the management of patients suffering for a SAPHO syndrome concerns the oral manifestations, the patient general health and the treatments he has to take every day.
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Affiliation(s)
- Clémence Ferreira-Vilaca
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France
| | - Leonor Costa Mendes
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France
- Laboratoire AMIS, UMR 5288 CNRS, Toulouse, France
- Reference Centre for Oral and Dental Rare Diseases, Toulouse, France
| | - Sophie-Caroline Campana
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France
| | - Isabelle Bailleul-Forestier
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France
- Reference Centre for Oral and Dental Rare Diseases, Toulouse, France
| | - Christine Audouin-Pajot
- Rheumatology Department, Toulouse University Hospital (CHU de Toulouse), 330 Avenue de Grande-Bretagne, 31300, Toulouse, France
| | - Rémi Esclassan
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France
- Laboratoire AMIS, UMR 5288 CNRS, Toulouse, France
| | - Thibault Canceill
- Dental Faculty, Paul Sabatier University, Toulouse University Hospital (CHU de Toulouse), 3 Chemin des Maraîchers, 31062 Cedex 9, Toulouse, France.
- CIRIMAT, University of Toulouse, CNRS, INPT, Université Paul Sabatier, Faculté de Pharmacie, 35 Chemin des Maraichers, 31062 Cedex 9, Toulouse, France.
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Timme M, Bohner L, Huss S, Kleinheinz J, Hanisch M. Response of Different Treatment Protocols to Treat Chronic Non-Bacterial Osteomyelitis (CNO) of the Mandible in Adult Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1737. [PMID: 32155902 PMCID: PMC7084792 DOI: 10.3390/ijerph17051737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
(1) Background: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disease of finally unknown etiology, which can occur alone or related with syndromes (chronic recurrent multifocal osteomyelitis-CRMO; synovitis, acne, pustulosis, hyperostosis and osteitis syndrome-SAPHO). The involvement of the mandible is rather rare. (2) Methods: We carried out a systematic literature search on CNO with mandibular involvement, according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines, considering the different synonyms for CNO, with a special focus on therapy. (3) Results: Finally, only four studies could be included. A total of 36 patients were treated in these studies-therefore, at most, only tendencies could be identified. The therapy in the included works was inconsistent. Various therapies could alleviate the symptoms of the disease. A complete remission could only rarely be observed and is also to be viewed against the background of the fluctuating character of the disease. The success of one-off interventions is unlikely overall, and the need for long-term therapies seems to be indicated. Non-steroidal anti-inflammatory drugs (NSAIDs) were not part of any effective therapy. Surgical therapy should not be the first choice. (4) Conclusions: In summary, no evidence-based therapy recommendation can be given today. For the future, systematic clinical trials on therapy for CNO are desirable.
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Affiliation(s)
- Maximilian Timme
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W 30, D-48149 Münster, Germany; (M.T.); (L.B.); (J.K.)
| | - Lauren Bohner
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W 30, D-48149 Münster, Germany; (M.T.); (L.B.); (J.K.)
| | - Sebastian Huss
- Department of Pathology, University Hospital Münster, Germany, Domagkstrasse 17, D-48149 Münster, Germany;
| | - Johannes Kleinheinz
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W 30, D-48149 Münster, Germany; (M.T.); (L.B.); (J.K.)
| | - Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W 30, D-48149 Münster, Germany; (M.T.); (L.B.); (J.K.)
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Hameed M, Horvai AE, Jordan RCK. Soft Tissue Special Issue: Gnathic Fibro-Osseous Lesions and Osteosarcoma. Head Neck Pathol 2020; 14:70-82. [PMID: 31950477 PMCID: PMC7021863 DOI: 10.1007/s12105-019-01094-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Abstract
Gnathic fibro-osseous lesions are a diverse group of disease processes which share overlapping microscopic features characterized by fibroblastic stroma with variable cellularity and a range of bone forming pathological processes leading to woven, sclerotic and cementum-like structures. Some of the lesions are unique to craniofacial location and a combination of clinical, radiological and pathological correlation is often necessary for diagnostic accuracy. Gnathic osteosarcomas are rare tumors with differences in age distribution and behavior as compared to osteosarcoma of long bones. This review will discuss the clinicopathological and radiological features of gnathic fibro-osseous lesions and osteosarcoma with updates on current genetics and molecular pathogenesis.
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Affiliation(s)
- Meera Hameed
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
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Kotaki S, Gamoh S, Yoshida H, Noma T, Tsuji K, Akiyama H, Yotsui Y, Iseki T, Shimizutani K. SAPHO syndrome of the temporomandibular joint associated with trismus: a case report and review of the literature. Oral Radiol 2019; 36:197-202. [PMID: 31414280 DOI: 10.1007/s11282-019-00405-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a disorder characterized by pustular skin lesions and osteoarticular lesions. Mandibular involvement occurs in approximately 10% of the cases, and is often seen as recurrent mandibular osteitis with bone sclerosis, mainly involving the body of the mandible in the head and neck region. Middle cranial base with temporomandibular joint (TMJ) involvement in SAPHO syndrome can be diagnostically challenging because of its rarity. Herein, we present a case of a 37-year-old man who suffered from trismus and dull pain in the left TMJ region. The initial panoramic image revealed spotty osteolysis around the left condylar head. Computed tomography (CT) images showed an osteosclerotic change in the middle cranial base including the TMJ. Magnetic resonance images showed a cortical bone change in the left TMJ without anterior disk displacement, with spotty low signal intensity in the left condyle bone marrow on T2- weighted images. Our initial diagnosis was osteomyelitis of the middle cranial base including the TMJ region. However, antimicrobial therapy, training for TMJ opening, and a surgical procedure were not effective. A detailed medical interview, careful check for skin lesions, and further imaging examinations including bone scintigraphy and chest CT led to the diagnosis of SAPHO syndrome. The possibility of SAPHO syndrome should be considered in patients suspected of osteomyelitis of the middle cranial base including the TMJ with unknown etiology.
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Affiliation(s)
- Shinya Kotaki
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan.
| | - Shoko Gamoh
- Health Promotion Division, Public Health Bureau, Osaka City Government, Osaka, Japan
| | - Hiroaki Yoshida
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University (ODU), Osaka, Japan
| | - Takaaki Noma
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University (ODU), Osaka, Japan
| | - Kaname Tsuji
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University (ODU), Osaka, Japan
| | - Hironori Akiyama
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Yoritaka Yotsui
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
| | - Tomio Iseki
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University (ODU), Osaka, Japan
| | - Kimishige Shimizutani
- Department of Oral Radiology, Osaka Dental University (ODU), 1-5-17 Otemae, Chuo-ku, Osaka, 540-0008, Japan
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Antao CJ, Dinkar AD, Khorate MM, Raut Dessai SS. Chronic Diffuse Sclerosing Osteomyelitis of the Mandible. Ann Maxillofac Surg 2019; 9:188-191. [PMID: 31293951 PMCID: PMC6585216 DOI: 10.4103/ams.ams_257_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic diffuse sclerosing osteomyelitis (CDSO) is a disease that presents a rather unusual clinicoradiographic picture creating diagnostic and therapeutic problems. Involvement of the temporomandibular joint is not frequently observed in CDSO. We report a unique case of a 37-year-old male with cyclic episodes of insidious swelling and progressive trismus for the past 4 years. Each episode was followed by spontaneous remission after 2 weeks. Radiographic examination detected unilateral coarse trabeculae with ground-glass appearance of the left hemimandible and resorption of ipsilateral condyle. Computed tomography demonstrated endosteal sclerosis, cortical thickening, and condylar resorption, while magnetic resonance imaging revealed altered marrow intensity with postcontrast enhancement of the surrounding musculature. Bone histopathology was consistent with the diagnosis of osteomyelitis. Palliative antibiotic therapy and regular follow-up were recommended. Of particular interest in the present case is ipsilateral condylar resorption not associated with any dermato-skeletal conditions, which is uncommon in CDSO of the mandible.
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Affiliation(s)
- Candice Jacinta Antao
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ajit Dattatray Dinkar
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Manisha Maruti Khorate
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Sapna S Raut Dessai
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
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Mandibular osteomyelitis related to SAPHO syndrome following dental implant surgery: A case report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Greenwood S, Leone A, Cassar-Pullicino VN. SAPHO and Recurrent Multifocal Osteomyelitis. Radiol Clin North Am 2017; 55:1035-1053. [DOI: 10.1016/j.rcl.2017.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Zwaenepoel T, Vlam KD. SAPHO: Treatment options including bisphosphonates. Semin Arthritis Rheum 2016; 46:168-173. [PMID: 27369452 DOI: 10.1016/j.semarthrit.2016.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Both the diagnosis and treatment of the syndrome of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) remain difficult. We describe a case series of 21 patients with SAPHO and their response to several pharmacological treatments. METHODS Clinical and biochemical data, along with medical imaging, were collected from the medical records of 21 patients, diagnosed as SAPHO during follow-up between 2005 and 2013. Symptoms and inflammatory markers were recorded twice, once at first patient presentation, and once at the end of follow-up. Synovitis, acne, pustulosis, hyperostosis, and osteitis were labeled as defining features. All treatment options were categorized according to their respective responses (full remission, partial remission, and no disease control). RESULTS There was a female predominance and a median age of 32 years (range: 12-54 years). Median follow-up duration was 45 months (range: 0-188 months). Total prevalence of defining features in this cohort increased for each defining feature during follow-up, except for acne. All patients reached full or partial remission at the end of follow-up. A total of 14 patients were treated with bisphosphonates. Of which 8 of them went into full or partial remission. DISCUSSION AND CONCLUSION In our case series, none of the patients had the full presentation of SAPHO at the first consultation. Some presented with symptoms suggestive for psoriatic arthritis. This explains why diagnosis of SAPHO can be challenging. Full remission was induced in the majority of individuals. Bisphosphonates seem to be a noteworthy treatment option. We suggest a prospective placebo-controlled clinical trial with bisphosphonates to confirm this observation.
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Affiliation(s)
- Tom Zwaenepoel
- Department of Rheumatology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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13
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Chou A, Schulman JM, Gross AJ, Jordan RC, Ramos DM. Gingival pustules and sterile diffuse sclerosing osteomyelitis as a feature of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 121:e116-22. [PMID: 26619759 DOI: 10.1016/j.oooo.2015.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome represents the rare co-occurrence of sterile inflammatory osteoarticular disease in association with a variety of cutaneous manifestations. Oral involvement is uncommon. The etiology of SAPHO is complex and is likely the combined result of infectious, genetic, and immunologic factors. Due to diverse clinical presentations, SAPHO is difficult to diagnose. Here, we describe the case of a 74-year-old man, who had a history of SAPHO syndrome and presented with gingival pustules and sterile diffuse sclerosing osteomyelitis of the mandible. This is the first case report describing neutrophilic mucositis as a feature of SAPHO.
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Affiliation(s)
- Annie Chou
- Department of Orofacial Sciences, University of California, San Francisco, USA.
| | - Joshua M Schulman
- Department of Pathology, University of California, San Francisco, USA; Department of Dermatology, University of California, San Francisco, USA
| | - Andrew J Gross
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, USA
| | - Richard C Jordan
- Department of Orofacial Sciences, University of California, San Francisco, USA; Department of Pathology, University of California, San Francisco, USA; Department of Radiation Oncology, University of California, San Francisco, USA
| | - Daniel M Ramos
- Department of Orofacial Sciences, University of California, San Francisco, USA
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14
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The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skeletal Radiol 2015; 44:9-24. [PMID: 25331355 DOI: 10.1007/s00256-014-2025-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 09/17/2014] [Accepted: 09/28/2014] [Indexed: 02/02/2023]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome includes a group of chronic, relapsing, inflammatory musculoskeletal disorders with similar manifestations, in particular synovitis, hyperostosis, and osteitis, which may or may not be associated with neutrophilic skin eruptions such as palmoplantar pustulosis and acne conglobata. The syndrome occurs at any age, can involve any skeletal site, and its imaging appearances are variable, depending on the stage/age of the lesion and imaging method. The diagnosis is difficult if there is no skin disease. Awareness of the imaging appearances, especially in the spine, may help the radiologist in avoiding misdiagnosis (e.g., infection, tumor) and unnecessary invasive procedures, while facilitating early diagnosis and selection of an effective treatment. In this article, we provide an overview of the radiological appearances of SAPHO syndrome, focusing on the magnetic resonance imaging findings of vertebral involvement, and present relevant clinical and pathological features that assist early diagnosis.
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15
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Diffuse sclerosing osteomyelitis (DSO) of the mandible in SAPHO syndrome: a novel approach with anti-TNF therapy. Systematic review. J Craniomaxillofac Surg 2014; 42:1990-6. [PMID: 25441866 DOI: 10.1016/j.jcms.2014.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/28/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022] Open
Abstract
Diffuse sclerosing osteomyelitis of the mandible is now considered a local manifestation of SAPHO syndrome. This rare condition is thought to be of auto-inflammatory origin. The myriad of treatments shown in the literature, are basically empirical and reflect its unknown origin. We present a clinical case of refractory DSO treated with an anti-TNF drug (etanercept) with complete clinical remission. We advise against radical surgery and an interdisciplinary approach is recommended. A systematic literature review was also conducted.
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