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Leal JVB, Del Santo LM, Mahboob ONMNK, Ramos TMM, Cavalcante MB, Pessoa Neto JV. Mandibular reconstruction with TMJ prosthesis: management of osteomyelitis after orthognathic surgery (Case Report). Oral Maxillofac Surg 2024; 28:957-962. [PMID: 37847424 DOI: 10.1007/s10006-023-01184-0] [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: 04/24/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis.
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Affiliation(s)
- Joao Victor Borges Leal
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil.
| | - Luciano Mauro Del Santo
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | | | - Thiago Martins Magalhães Ramos
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | - Mateus Barros Cavalcante
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
| | - José Valdir Pessoa Neto
- Neo Face Clinic - Oral-Maxillofacial Department, Neo Face Cirurgia Bucomaxilofacial Institute, Avenida Vereador José Diniz, 3725 - Cj. 81 Campo Belo, Sau Paulo, Brazil
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Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Radiological manifestations and clinical findings of patients with oncologic and osteoporotic medication-related osteonecrosis of the jaw. Sci Rep 2024; 14:8744. [PMID: 38627515 PMCID: PMC11021436 DOI: 10.1038/s41598-024-59500-x] [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: 12/14/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) poses a challenging form of osteomyelitis in patients undergoing antiresorptive therapies in contrast to conventional osteomyelitis. This study aimed to compare the clinical and radiological features of MRONJ between patients receiving low-dose medications for osteoporosis and those receiving high-dose medications for oncologic purposes. The clinical, panoramic radiographic, and computed tomography data of 159 patients with MRONJ (osteoporotic group, n = 120; oncologic group, n = 39) who developed the condition after using antiresorptive medications for the management of osteoporosis or bone malignancy were analyzed. The osteoporotic group was older (75.8 vs. 60.4 years, p < 0.01) and had a longer duration of medication usage than the oncologic group (58.1 vs. 28.0 months, p < 0.01). Pus discharge and swelling were more common in the osteoporotic group (p < 0.05), whereas bone exposure was more frequent in the oncologic group (p < 0.01). The mandibular cortical index (MCI) in panoramic radiographs was higher in the osteoporotic group (p < 0.01). The mean sequestra size was larger in the oncologic group than in the osteoporotic group (15.3 vs. 10.6 mm, p < 0.05). The cured rate was significantly higher in the osteoporotic group (66.3% vs. 33.3%, p < 0.01). Oncologic MRONJ exhibited distinct clinical findings including rapid disease onset, fewer purulent signs, and lower cure rates than osteoporotic MRONJ. Radiological features such as sequestrum size on CT scan, and MCI values on panoramic radiographs, may aid in differentiating MRONJ in osteoporotic and oncologic patients.
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Affiliation(s)
- Jeong Won Shin
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Dudde F, Henkel KO, Barbarewicz F. The "Lumpy Jaw" Disease-Treatment and Diagnostical Challenge of Actinomycotic Osteomyelitis. J Maxillofac Oral Surg 2024; 23:328-329. [PMID: 38601245 PMCID: PMC11001794 DOI: 10.1007/s12663-023-02069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/04/2023] [Indexed: 04/12/2024] Open
Abstract
Background Osteomyelitis is a serious entity that can occur in many different locations. Especially in the mandible, osteomyelitis can show different clinical courses, which differ clearly from other anatomical regions in terms of severity and treatment. Osteomyelitis in the mandible is often caused by mixed species of the oral cavity. A species causing subacute/chronic osteomyelitis can be actinomyces. Actinomycotic osteomyelitis of the jaw represents a diagnostic and treatment challenging disease. Conclusion This article describes our perspective on the therapy pillars treating actinomycotic osteomyelitis. The rapid introduction of the two therapeutic elements (antibiosis/surgical therapy) is crucial regarding the outcome of this entity.
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Affiliation(s)
- Florian Dudde
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Lesserstraße 180, 22049 Hamburg, Germany
| | - Kai-Olaf Henkel
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Lesserstraße 180, 22049 Hamburg, Germany
| | - Filip Barbarewicz
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Lesserstraße 180, 22049 Hamburg, Germany
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Patil AH, Singh S, Bedia AS, Sharma D, Sinha A, Dahiya N. Lesions Misdiagnosed as Endodontic Pathosis: A Narrative Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S11-S13. [PMID: 38595444 PMCID: PMC11001139 DOI: 10.4103/jpbs.jpbs_461_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 04/11/2024] Open
Abstract
In daily practice, clinicians come across certain radiographic abnormalities which may or may not be asymptomatic. This abstract discusses radiographic abnormalities encountered by clinicians in daily practice, some of which resemble endodontic lesions. Prompt attention is crucial as these lesions can be benign or malignant. The article emphasizes the importance of differential diagnosis for accurate identification of periapical pathosis.
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Affiliation(s)
- Amit Hemraj Patil
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Shruti Singh
- Final Year, Bachelor of Dental Surgery Student, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Aarti S. Bedia
- Department of Oral Medicine and Oral Radiology, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Deepak Sharma
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Anamika Sinha
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Nitesh Dahiya
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University), Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Fenelon M, Gernandt S, Aymon R, Scolozzi P. Identifying Risk Factors Associated with Major Complications and Refractory Course in Patients with Osteomyelitis of the Jaw: A Retrospective Study. J Clin Med 2023; 12:4715. [PMID: 37510830 PMCID: PMC10380926 DOI: 10.3390/jcm12144715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Despite improved knowledge regarding the diagnosis and treatment of osteomyelitis of the jaw (OMJ), it remains a clinical challenge for oral and maxillofacial surgeons. This study aimed to identify risk factors associated with severe forms of OMJ, i.e., related to the occurrence of major complications or the refractory course of the disease. A retrospective study was performed based on the medical records of all patients diagnosed with OMJ from the past 20 years. Collected data included demographic information, medical and dental history, clinical, radiological, and bacterial findings as well as treatment modalities. The main outcome variables were the onset of major complications and treatment results. Fifty-four patients were included. Our results showed that alcohol and smoking habits, as well as malnutrition, were significantly associated with the occurrence of major complications. We also established that dental implant-induced OMJ should be considered an aggressive subtype of OMJ. Finally, clinical bone exposure was significantly associated with unfavorable outcomes, whereas dental causes or radiological evidence of periosteal reaction were predictive of successful outcomes. Identifying such factors could be useful in preventing serious complications and informing patients about the refractory course of the disease based on the presence of these factors.
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Affiliation(s)
- Mathilde Fenelon
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- UFR des Sciences Odontologiques, University Bordeaux, 33000 Bordeaux, France
- Service de Chirurgie Orale, CHU de Bordeaux, 33000 Bordeaux, France
| | - Steven Gernandt
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Romain Aymon
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
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Diagnostic utility of magnetic resonance imaging texture analysis in suppurative osteomyelitis of the mandible. Oral Radiol 2022; 38:601-609. [PMID: 35157182 DOI: 10.1007/s11282-022-00595-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to determine the diagnostic utility of magnetic resonance imaging (MRI) texture analysis for evaluating mandibular suppurative osteomyelitis (OM). MATERIALS AND METHODS In this retrospective cohort study, we analyzed the records of 50 patients with and without OM who underwent MRI between April 2019 and March 2021. The presence or absence of OM served as a predictor variable. The outcome variables were the texture features of the region of interest, which were analyzed. Quantitative parameters based on histogram features (90th percentile) and gray-level co-occurrence matrix (GLCM) features (Sum Averg) were calculated using short-tau inversion-recovery data with a region of interest. These six features out of 279 parameters were selected using Fisher, probability of error, and average correlation coefficient methods in MaZda. For the analysis of trivariate statistics, the post-Mann-Whitney test of the Kruskal-Wallis test with Bonferroni adjustment was used, and the p value was set to 0.05. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic effect of texture function to distinguish between acute and chronic diseases. RESULTS One histogram feature and five GLCM features showed differences among the non-OM patients, acute OM patients, and chronic OM patients (p < 0.05). The ROC analysis revealed a high area under the curve ranging from 0.91 to 0.96 for six texture features. CONCLUSION The six texture features of the mandibular bone marrow demonstrated differences among patients without and with acute and chronic OM. MRI texture analysis may facilitate accurate assessment of the mandibular OM stage.
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Xue J, Jia K, Li T, Zhang J, An J. GNAS mutation analysis assists in differentiating chronic diffuse sclerosing osteomyelitis from fibrous dysplasia in the jaw. Mod Pathol 2022; 35:1334-1340. [PMID: 35672467 DOI: 10.1038/s41379-022-01103-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/23/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
Chronic diffuse sclerosing osteomyelitis of the mandible (DSOM) and fibrous dysplasia (FD) are distinct lesions with overlapping clinicopathological features that complicate their diagnosis. This study aimed to evaluate the efficacy of GNAS mutation analysis in differentiating between these two conditions. DNA samples from patients with DSOM (n = 35) and FD (n = 29) were collected to analyze the presence of GNAS mutations in exons 8 and 9, the two previously reported hotspot regions, using polymerase chain reaction and direct sequencing. Twenty-four of 29 patients (83%) with FD showed missense mutations in codon 201 in exon 8, whereas no mutation was detected in exon 9. No mutations were found in any of the 35 cases with DSOM. We also identified one case with an uncertain diagnosis due to overlapping clinicopathological features of DSOM and FD. A Q227H mutation was detected in this case, that confirmed the diagnosis of FD. Taken together, the findings indicate that mutational analysis of the GNAS is a reliable approach to differentiate between DSOM and FD of the jaw.
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Affiliation(s)
- Jiang Xue
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, 22 South Avenue Zhongguancun, Haidian District, Beijing, 100081, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China.,Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, PR China
| | - Kuankuan Jia
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China.,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Avenue Zhongguancun, Haidian District, Beijing, 100081, PR China
| | - Tiejun Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, 22 South Avenue Zhongguancun, Haidian District, Beijing, 100081, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China.,Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, PR China
| | - Jianyun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, 22 South Avenue Zhongguancun, Haidian District, Beijing, 100081, PR China. .,National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China. .,Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, PR China.
| | - Jingang An
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China. .,Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, 22 South Avenue Zhongguancun, Haidian District, Beijing, 100081, PR China.
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van de Meent MM, Appelman-Dijkstra NM, Wetselaar-Glas MJM, Pichardo SEC, van Merkesteyn JPR. Bisphosphonate therapy in chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: Retrospective case series. J Craniomaxillofac Surg 2022; 50:599-604. [PMID: 35768318 DOI: 10.1016/j.jcms.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/26/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022] Open
Abstract
This study aims to evaluate short-term and long-term results of bisphosphonate therapy in patients with diffuse sclerosing osteomyelitis/tendoperiostitis (DSO/TP) of the mandible. Eighteen patients (12 female, 6 male) aged 34.8 ± 22.2 years with DSO/TP of the mandible that were treated with bisphosphonates were included. In 16 patients, the bisphosphonate treatment led to remission with decrease of symptoms (pain, swelling of the cheek, trismus, tenderness of masticatory muscles) with a follow-up period of 4.5 (0.8-11.9) years between start of bisphosphonate treatment and latest follow-up consult. Of these, three patients were still in need of regular bisphosphonate therapy. Two patients were lost to follow-up. Bisphosphonate therapy is a treatment option for DSO/TP of the mandible that is associated with a high chance of remission of symptoms. Within the limitations of the study it seems that this treatment might be an effective second step in DSO/TP refractory to conservative treatment.
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Affiliation(s)
- Marieke M van de Meent
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Natasha M Appelman-Dijkstra
- Centre for Bone Quality, Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Sarina E C Pichardo
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
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Chronic Osteomyelitis With Proliferative Periostitis of the Mandible in a Child: Report of a Case Managed by Immunosuppressive Treatment. Pediatr Infect Dis J 2022; 41:e10-e15. [PMID: 34711782 DOI: 10.1097/inf.0000000000003368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Osteomyelitis with proliferative periostitis is a relatively uncommon inflammatory condition of the jaws, mainly characterized by periosteal formation of reactive bone. It primarily affects children and adolescences, also referred to as Garre's osteomyelitis, more frequently involving the molar region of the mandible. Cases lacking an obvious source of infection may have an immunologically mediated etiopathogenesis, falling under the spectrum of primary chronic osteomyelitis or chronic recurrent multifocal osteomyelitis (CRMO). CASE REPORT Herein, we present a case of chronic osteomyelitis in a 6.5-year-old girl, who suffered from recurrent painful episodes of swelling of the mandible for the last 2 years, previously requiring hospitalization and administration of intravenous (IV) antibiotics and NSAIDs with limited responsiveness. The biopsy showed features consistent with osteomyelitis with proliferative periostitis. The patient was initially managed with an IV combination antibiotic regimen with only partial improvement. The possibility of an autoimmune mechanism in the context of primary chronic osteomyelitis or CRMO was considered, and immunosuppressive therapy (TNF inhibitor etanercept along with corticosteroids and methotrexate) was administered, resulting in clinical resolution. CONCLUSIONS Osteomyelitis and its childhood variants are relatively rare and their management presents several challenges. Although typically treated with administration of antibiotics, possibly along with surgical intervention, other treatment modalities may be necessary for resilient and persistent cases. In a subset of cases, especially in the absence of local infectious factors, immunologically mediated mechanisms may play an important role and appropriate immunosuppressive therapy may be effective.
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Muraoka H, Hirahara N, Ito K, Okada S, Kondo T, Kaneda T. Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis of osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:80-87. [PMID: 34301502 DOI: 10.1016/j.oooo.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This retrospective cohort study aimed to determine the diagnostic utility of apparent diffusion coefficient (ADC) values in the quantitative evaluation of mandibular osteomyelitis. METHODS We analyzed the records of 70 patients aged 30 to 90 years, with and without osteomyelitis, who underwent magnetic resonance imaging at the Nihon University School of Dentistry between April 2017 and March 2019. The mean ADC of bone marrow of patients without osteomyelitis and those with acute and chronic osteomyelitis of the mandible were calculated. Differences in ADC overall and in pair-wise comparisons were analyzed. Correlations with patient age were also calculated. RESULTS The mean ADC values in the nonosteomyelitis, acute osteomyelitis, and chronic osteomyelitis groups were 0.87 ± 0.15 × 10-3, 1.24 ± 0.11 × 10-3, and 1.07 ± 0.13 × 10-3 mm2/s, respectively (P < .001 for all pair-wise comparisons). Receiver operating characteristic curve analysis revealed an ADC cut-off of 0.98 for osteomyelitis. Diagnostic values for predicting osteomyelitis were ≥ .81. No correlations of osteomyelitis with age were found. CONCLUSIONS The ADC was significantly higher in the osteomyelitis groups than in the nonosteomyelitis group. This suggests that ADC may be a useful parameter for quantitative evaluation of mandibular osteomyelitis.
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Affiliation(s)
- Hirotaka Muraoka
- Assistant Professor, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan.
| | - Naohisa Hirahara
- Assistant Professor, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Kotaro Ito
- Assistant Professor, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Shunya Okada
- Graduate student, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takumi Kondo
- Graduate student, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
| | - Takashi Kaneda
- Professor, Department of Radiology, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba, Japan
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Chacko R, Kumar S, Verghese VP, Charllu AP. Methicillin-resistant Staphylococcus aureus (MRSA)-associated juvenile osteomyelitis of mandible: a rare variant. BMJ Case Rep 2021; 14:14/7/e244141. [PMID: 34301708 DOI: 10.1136/bcr-2021-244141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mandibular osteomyelitis in paediatric population presents as painful swelling with progressive trismus. Often the aetiology for this form of progressive osteomyelitis is inconclusive. The infective aetiology in this condition is difficult to assign as bone tissue culture is found to be seldom positive. We present a case of an 11-year-old girl, with hearing and speech impairment, who presented with report of painful right-sided mandibular swelling with progressive trismus. Clinical, radiographic and histopathological findings were suggestive of sclerotic osteomyelitis. Bone tissue culture grew Methicillin-resistant Staphylococcus aureus, indicating a rare infective variant. Unlike the common belief, where osteomyelitic mandible needs a combination of medical and surgical management, our case was managed conservatively with only antibiotic therapy. Our patient responded well to the treatment with reduction in pain and gradual improvement in the mouth opening. Radiographically the mandibular involvement also showed complete regression.
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Affiliation(s)
- Rabin Chacko
- Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Saurabh Kumar
- Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Valsan Philip Verghese
- Pediatric Infectious Diseases, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Arun Paul Charllu
- Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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Barreda Hale M, Romero-Araya P, Cea Herrera M, Espinoza D, Castro N, Castro J, Serandour G. Computer-assisted planning with 3D printing for mandibular reconstruction caused by a mandibular fracture with secondary osteomyelitis: A Case Report. Clin Case Rep 2021; 9:e04410. [PMID: 34295476 PMCID: PMC8287308 DOI: 10.1002/ccr3.4410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 01/24/2023] Open
Abstract
Mandibular reconstructions are complex clinical pictures that require careful planning for functional and aesthetic outcomes. Virtual surgical planning and 3D printing are ideal to achieve a predictable result. Through "hybrid techniques" (prebending plates with 3D-models) and free software, this goal is within reach for clinics with limited financial resources.
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Affiliation(s)
- Mauricio Barreda Hale
- Cirujano Oral y Maxilofacial Universidad de Chile Servicio Cirugía Oral y Maxilofacial Hospital del Salvador Servicio de Cirugía Maxilofacial Hospital San Borja Arriaran Santiago Chile
| | - Pablo Romero-Araya
- Escuela de Odontología Facultad de Medicina Universidad Austral de Chile Valdivia Chile
- Cirujano Dentista Universidad Austral de Chile Valdivia Chile
- Odontóloga en Etapa de Destinación y Formación CESFAM Mariquina Valdivia Chile
- Cirujano Oral y Maxilofacial Universidad de Los Andes Santiago Chile
- LeufüLAB Facultad de Ciencias de la Ingeniería Universidad Austral de Chile Valdivia Chile
| | - Macarena Cea Herrera
- Cirujano Dentista Universidad Austral de Chile Valdivia Chile
- Odontóloga en Etapa de Destinación y Formación CESFAM Mariquina Valdivia Chile
| | - Daniela Espinoza
- Cirujano Oral y Maxilofacial Universidad de Los Andes Santiago Chile
| | - Nicolas Castro
- LeufüLAB Facultad de Ciencias de la Ingeniería Universidad Austral de Chile Valdivia Chile
| | - Joaquín Castro
- LeufüLAB Facultad de Ciencias de la Ingeniería Universidad Austral de Chile Valdivia Chile
| | - Guillaume Serandour
- LeufüLAB Facultad de Ciencias de la Ingeniería Universidad Austral de Chile Valdivia Chile
- Instituto de Diseño y Métodos Industriales Facultad de Ciencias de la Ingeniería, Universidad Austral de Chile Valdivia Chile
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Rodríguez-Cuentas GK. [Clinical and imaging characteristics of familial gigantiform cementoma. A review of the literature]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e073. [PMID: 38464860 PMCID: PMC10919829 DOI: 10.21142/2523-2754-0903-2021-073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/15/2021] [Indexed: 03/12/2024] Open
Abstract
Familial gigantiform cementoma (FGC) is a rare benign fibro-cementum lesion, which follows an autosomal dominant inheritance pattern and presents during childhood. It is limited to the bones of the face, with a predilection for the jaw, is fast growing and painless and expands considerably over time. It is considered among the seven disorders that affect the physiognomy of the craniofacial skeleton. Radiographically, FGC occurs in three stages of maturation similar to bone dysplasia, being radiolucent, mixed and radiopaque and is described as a mixed lobular well delimited mass, which can occur in both maxillae, causing expansion of the buccal and palatal / lingual bone cortices. displacement and retention of teeth. The aim of this study was to perform a review of the literature to identify the clinical, radiographic and histopathological characteristics of FGC in the jaws and describe the imaging tools that are useful for the diagnosis and follow-up of this lesion.
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Affiliation(s)
- Grizel Karem Rodríguez-Cuentas
- Facultad de Odontología, Universidad de Aquino Bolivia. Oruro, Bolivia. Universidad de Aquino Bolivia Facultad de Odontología Universidad de Aquino Bolivia Oruro Bolivia
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Jia K, Li T, An J. Is Operative Management Effective for Non-Bacterial Diffuse Sclerosing Osteomyelitis of the Mandible? J Oral Maxillofac Surg 2021; 79:2292-2298. [PMID: 34339621 DOI: 10.1016/j.joms.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Operative management has been reported to show varying degrees of therapeutic effects for non-bacterial diffuse sclerosing osteomyelitis of the mandible (DSOM). The purpose of this study was to retrospectively analyze and summarize the operative outcomes for non-bacterial DSOM. METHODS In this retrospective cohort study, patients with non-bacterial DSOM who received operative treatment were enrolled at the Peking University Hospital of Stomatology between 2012 and 2019. The primary predictor variables were the type of operative treatment and number of operations. The outcome variables were operative outcomes (symptom relief or ineffective) and time to recurrent symptoms after operations. Other study variables were demographics, including sex, age, and non-bacterial DSOM onset time. The χ2 test and Kaplan-Meier model were used to evaluate differences. RESULTS The sample was composed of 72 patients with a mean age at onset of 26.1 ± 17.8 years and showed a female predilection. Decortication was performed for 68 patients with non-bacterial DSOM, and 4 patients underwent segmental mandibulectomy. Symptom relief was achieved in 37 (54.4%) patients after the first decortication, and the median time to symptom recurrence was 2.0 months. Furthermore, the longest time to symptom recurrence was not more than 6 months in all patients. Among the 4 patients who underwent segmental mandibulectomy, 2 who received fibula repair experienced recurrence of symptoms at 4 and 5 months after the operations, respectively, and their normal mandible and the transplanted fibula also presented with imaging manifestations of osteomyelitis. CONCLUSIONS Decortication and segmental mandibulectomy were not effective for non-bacterial DSOM. This finding is consistent with the results of other reports, and this condition may be best managed non-operatively by rheumatologists.
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Affiliation(s)
- Kuankuan Jia
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tongtong Li
- Clinical Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jingang An
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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15
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LIEVERSE ANGELAR, KUBO DAISUKE, BOURGEOIS REBECCAL, MATSUMURA HIROFUMI, YONEDA MINORU, ISHIDA HAJIME. Pediatric mandibular osteomyelitis: a probable case from Okhotsk period (5th–13th century AD) northern Japan. ANTHROPOL SCI 2021. [DOI: 10.1537/ase.2108281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - DAISUKE KUBO
- Faculty of Medicine, Hokkaido University, Sapporo
| | | | | | | | - HAJIME ISHIDA
- Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara
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16
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Periostitis Ossificans: Report of Two Cases Resolved with Endodontic Treatment. Case Rep Dent 2020; 2020:8876268. [PMID: 33299618 PMCID: PMC7707965 DOI: 10.1155/2020/8876268] [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: 09/16/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Periostitis ossificans is a chronic disease characterized by an ossifying periostitis, occurring in children and young adults, commonly as a reaction to a mild infection or irritation. It is also characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic radiographic appearance of “onion skin.” Aim. The aim of this paper was to present the clinical and radiographic findings, as well as the postoperative follow-up of two cases diagnosed with periostitis ossificans of dental origin, and to discuss the differential diagnosis and treatment modalities. Case Reports. In the first case, a 16-year-old adolescent was referred for a persistent mandibular swelling. Intraoral examination showed two sinus tracts in relation to the carious necrotic left mandibular first molar. The periapical radiograph showed a periapical lesion in relation to the two root canals of the left mandibular first molar. Occlusal radiographs revealed the “onion skin” bone formation aspect. In the second case, a 10-year-old girl presented to our department with a slightly painful mandibular swelling. The periapical radiograph showed a periapical lesion in relation to both the mesial and distal roots of the carious necrotic right mandibular first molar. Cone beam computed tomography (CBCT) showed a subperiosteal bone formation with an “onion skin” aspect. Diagnosis of periostitis ossificans in the two cases was confirmed and the lesion was resolved by simply an endodontic treatment. Conclusion. Specific attention should be given to clinical and radiographic exploration in case of children with mandibular swelling. As osteosarcoma can be misdiagnosed, additional examinations, such as computed tomography, can be useful in differential diagnosis and in searching malignancy signs.
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17
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A clinicopathologic analysis of 135 cases of cemento-osseous dysplasia: To operate or not to operate? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:278-282. [PMID: 32565263 DOI: 10.1016/j.jormas.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this retrospective study was to investigate the characteristics of cemento-osseous dysplasia (COD) lesions for devising a clinical algorithm to help management decisions, specifically discussing the need for a possible surgical intervention versus solely follow-up. MATERIALS AND METHODS One hundred thirty-five subjects were thus identified having previously diagnosed and treated for COD from the archives of the pathology in between 2005-2015. These were then re-evaluated. Demographic features, radiographic and histopathologic findings were assessed. RESULTS The most frequent variant was the focal type (n=83), and the mandible (n=131) was predominantly affected jaw bone. Female predilection was evident for all subtypes. Almost half of the lesions (n=72) presented with mixed radiolucent and radiopaque appearances in radiography at the time of the biopsy. Cementicles/psammoma body-like calcifications and trabecular pattern were the most common hard tissue appearances. CONCLUSION COD lesions are non-neoplastic fibro-osseous lesions which can exhibit similar histopathologic and radiologic features with other bone lesions. Ideally, these lesions should be clinically identified and followed-up. Considering the possible complications, a thorough knowledge of these lesions and their differentials is essential in order to avoid unnecessary surgical interventions.
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18
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Outcome of different treatments for chronic diffuse sclerosing osteomyelitis of the mandible: a systematic review of published papers. Br J Oral Maxillofac Surg 2020; 58:385-395. [DOI: 10.1016/j.bjoms.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
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19
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Gaal A, Basiaga ML, Zhao Y, Egbert M. Pediatric chronic nonbacterial osteomyelitis of the mandible: Seattle Children's hospital 22-patient experience. Pediatr Rheumatol Online J 2020; 18:4. [PMID: 31941491 PMCID: PMC6964064 DOI: 10.1186/s12969-019-0384-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Studies evaluating treatment responses for chronic nonbacterial osteomyelitis (CNO) are lacking. We aimed to measure and compare response rates of medical treatments, time to response of medical treatments among patients with CNO of the mandible, and describe bacterial contamination rates from biopsy. METHODS We conducted a retrospective chart review of all patients diagnosed with CNO of mandible between 2003 and 2017 and extracted demographic, clinical, laboratory, imaging and surgical data. Detailed medication use and response to medications were recorded. The primary outcome was response to medical treatments defined as improvement of presenting symptoms, inflammatory markers, and imaging if available. Medical treatments included nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, disease modifying anti rheumatic drugs (DMARDs), anti-tumor necrosis factor (TNF) therapy, and pamidronate. Descriptive analysis was performed when appropriate. Multivariable logistic regression and Kaplan-Meier curves were applied to compare the responses to medical treatments and time to full response. RESULTS We identified 22 patients with a median age of 11 and 36% were female. Four patients (18%) had multifocal bone lesions. CT findings (n = 21) showed lytic lesions (62%) and sclerosis (90%). MRI (n = 14) revealed hyperintensity within bone marrow (100%), soft tissue (71%) and bony expansion (71%). Non-antibiotic treatments including NSAIDs (n = 18), glucocorticoids (n = 10), DMARDs (n = 9), anti-TNF therapy (n = 5) and pamidronate (n = 6) were applied. Rates of full responses to anti-TNF therapy (60%) and pamidronate (67%) were higher than that to NSAIDs (11%) (p < 0.05). Patients receiving pamidronate responded more rapidly than those receiving anti-TNF therapy (median two vs 17 months, p = 0.01) when there was a full response. All had bone biopsies. Intraoral biopsy was performed in 12 of 13 operated in our center and the most common contaminants were Neisseria spp and Streptococcus viridians. CONCLUSION Both anti-TNF and pamidronate appeared superior to NSAIDs alone in treating mandibular CNO. Patients receiving pamidronate responded faster than those receiving anti-TNF therapy.
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Affiliation(s)
- Austin Gaal
- 0000000122986657grid.34477.33Department of Oral and Maxillofacial Surgery, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Matthew L. Basiaga
- 0000 0004 0459 167Xgrid.66875.3aPediatric Rheumatology, Mayo Clinic, Rochester, MN USA
| | - Yongdong Zhao
- 0000000122986657grid.34477.33Pediatric Rheumatology, Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - Mark Egbert
- Pediatric Oral and Maxillofacial Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
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20
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Osteomyelitis of the Mandible Caused by Late Fracture following Third Molar Extraction. Case Rep Dent 2019; 2019:5421706. [PMID: 31467733 PMCID: PMC6701314 DOI: 10.1155/2019/5421706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
Abstract
The common postoperative complications of the extraction of third molars are frequently reported; however, reports about osteomyelitis of the mandible caused by late fracture following third molar extraction are rare. Here, we report a case of osteomyelitis of the mandible caused by late fracture following third molar extraction. A 38-year-old Japanese man was referred to the surgery department with chief complaints of dull pain and swelling in the right masseteric region and paresthesia of his lower lip and mental region in March 2018. A family dentist removed his lower third molar in the right side in January 2018. When the patient was chewing an innards stew 23 days after the procedure, he heard a cracking sound from the right mandible. Thus, we diagnosed the patient as having osteomyelitis of the mandible caused by late fracture following third molar extraction and performed sequestrectomy and curettage under general anesthesia in April 2018. In conclusion, it is necessary to recognize the possibility that late fracture following third molar extraction can cause osteomyelitis. Furthermore, once osteomyelitis of the mandible caused by late fracture occurred, early and appropriate treatment is necessary because the osteomyelitis may progress rapidly and in some cases may result in pathological fracture.
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21
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Spinal and sacroiliac involvement in SAPHO syndrome: A single center study of a cohort of 354 patients. Semin Arthritis Rheum 2019; 48:990-996. [DOI: 10.1016/j.semarthrit.2018.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/31/2018] [Accepted: 09/17/2018] [Indexed: 01/02/2023]
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22
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Liu D, Zhang J, Li T, Li C, Liu X, Zheng J, Su Z, Wang X. Chronic osteomyelitis with proliferative periostitis of the mandibular body: report of a case and review of the literature. Ann R Coll Surg Engl 2019; 101:328-332. [PMID: 30855166 DOI: 10.1308/rcsann.2019.0021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic osteomyelitis with proliferative periostitis is a rare form of osteomyelitis that is characterised by new bone formation with periosteal reaction. It is also traditionally known as Garre's osteomyelitis. The common sources of infection of the jaw include dental caries associated with periapical periodontitis, periodontitis, fractures and nonodontogenic infections. Chronic osteomyelitis with proliferative periostitis mainly presents in younger patients. Here, we present a case of a 12-year-old patient with chronic osteomyelitis with proliferative periostitis with no definitive infection source such as pericoronitis, caries and periodontitis. Therapeutic measures involved surgical debridement and antibiotics. Disease remission and a normal facial symmetrical morphology were observed at the six-month follow-up.
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Affiliation(s)
- D Liu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - J Zhang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Orthodontics, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - T Li
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - C Li
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - X Liu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - J Zheng
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - Z Su
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
| | - X Wang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University , Jinan, Shandong Province , China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University , Jinan, Shandong Province , China
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Kudva A, Kamath AT, Dhara V, Ravindranath V. Chronic recurrent osteomyelitis: A surgeon's enigma. J Oral Pathol Med 2019; 48:180-184. [PMID: 30565322 DOI: 10.1111/jop.12814] [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] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis. METHODS A thorough workup which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti-inflammatory with or without surgical debridement/adjuvant therapies. Correlation of our findings and treatment plan was done with evidence-based literature and practice. RESULTS Complete resolution of symptoms with radiographic evidence was achieved in both the cases. In the recurrence period, long-term steroids, NSAIDs, antibiotics resulted in better outcomes. CONCLUSION The evidence-based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom-free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Abhay T Kamath
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Vasantha Dhara
- Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - Vineetha Ravindranath
- Department of Oral Medicine & Radiology, Manipal College of Dental Sciences, Manipal, Karnataka, India
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24
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D'souza V, Martis E, Reddy K, Rao P, KB R, Kini R, Hegde S. Chronic sclerosing osteomyelitis: A case report on a rare complication of tooth extraction. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_74_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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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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26
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Garre's Osteomyelitis of the Mandible Caused by Infected Tooth. Case Rep Dent 2018; 2018:1409539. [PMID: 30073097 PMCID: PMC6057339 DOI: 10.1155/2018/1409539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/28/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022] Open
Abstract
Aim Garre's osteomyelitis is a local thickening of the periosteum caused by a slight irritation or infection. We aimed to present the extraoral, intraoral, and radiographic findings and postoperative pursuits of two patients diagnosed with Garre's osteomyelitis. In this case report, although clinical findings indicate infection source, these clinical findings are strongly supported by cone-beam computed tomography images. In addition, it can be seen that when we have followed the case I, we have chosen the right path in treatment. Case Reports Two patients presented to our clinic due to severe swelling and facial asymmetry in the right and left mandibular region. As a result of the clinical and radiological examinations, the patients were diagnosed with Garre's osteomyelitis. Infected teeth that were responsible for the formation of Garre's osteomyelitis were extracted under antibiotic treatment in both cases. A complete improvement in postoperative control was observed in case I. On the other hand, the other case could not be followed up postoperatively. Conclusion In Garre's osteomyelitis, new bone formation can occur in many pathological conditions. Therefore, it should be distinguished from other pathologies that cause new bone formation, such as Ewing's sarcoma, Caffey disease, and fibrous dysplasia.
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27
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Mandibular Osteitis Leading to the Diagnosis of SAPHO Syndrome. Case Rep Radiol 2018; 2018:9142362. [PMID: 30009075 PMCID: PMC6020456 DOI: 10.1155/2018/9142362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/26/2018] [Indexed: 11/18/2022] Open
Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a disorder characterized by pustular skin lesions and osteoarticular lesions. Mandibular involvement of SAPHO syndrome is clinically rare, and it is difficult to reach a diagnosis of SAPHO syndrome from only mandibular manifestations. This report describes the case of a 26-year-old woman who presented with mandibular osteitis. Orthopantomogram and computed tomography showed sclerotic change of the right body of the mandible with periosteal reaction without odontogenic infection, which suggested the possibility of SAPHO syndrome. Detailed medical interview found that she had a history of palmoplantar pustulosis treated at a local dermatology clinic and additional bone scintigraphy showed diffuse increased uptake in the right mandible, as well as in the sternum and the sternocostoclavicular joints. She was eventually diagnosed as having SAPHO syndrome. We should consider SAPHO syndrome when we encounter a patient with mandibular osteitis of unknown etiology.
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28
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Haeffs TH, Scott CA, Campbell TH, Chen Y, August M. Acute and Chronic Suppurative Osteomyelitis of the Jaws: A 10-Year Review and Assessment of Treatment Outcome. J Oral Maxillofac Surg 2018; 76:2551-2558. [PMID: 30509394 DOI: 10.1016/j.joms.2018.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To review cases of suppurative osteomyelitis of the jaws treated at the Massachusetts General Hospital (Boston, MA) over a 10-year period, evaluate specifics of disease presentation, and answer the clinical question: are there identifiable variables associated with treatment outcome? MATERIALS AND METHODS A retrospective cohort study was completed using patients treated for suppurative osteomyelitis of the jaws at the Massachusetts General Hospital from April 2006 to October 2016. Inclusion criteria were a diagnosis of suppurative osteomyelitis of the jaw, age older than 18 years, and complete medical records. Patients with nonsuppurative disease, radiation history, or antiresorptive exposure were excluded. Candidate variables included demographic information, medical and dental history, presenting signs and symptoms, and radiologic and laboratory findings. The outcome variable was successful treatment, defined as resolution of symptoms and radiographic evidence of healing after initial treatment. Appropriate statistical analyses were performed with significance set a P value less than .05. RESULTS Forty-two patients met the inclusion criteria. Mean age was 53 years (range, 20 to 80 yr) and 26 were women (62%). Common comorbidities included cardiovascular disease (52%), tobacco use (45%), and psychiatric disorders (45%). Pain (90%), swelling (86%), and neurosensory change (50%) were the most common findings. Common microbacterial isolates included Streptococcus milleri (74%) and coagulase-negative Staphylococcus species (43%), which showed marked antibiotic resistance. Surgical debridement was the most common intervention (93%). Successful treatment was found in 86%. Of 6 persistent cases, 4 resolved with a second debridement and continued antibiotics and 2 required resection. Increased white blood cell (WBC) count at presentation (P = .005) and associated psychiatric diagnoses (P = .037) were statistically associated with unsuccessful initial treatment. CONCLUSION The results of this study indicate that antibiotic resistance is commonly encountered in this patient population, although it was not associated with unsuccessful outcome. Patients presenting with increased WBC count and concurrent psychiatric comorbidities required protracted treatment.
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Affiliation(s)
- Tyler H Haeffs
- Predoctoral Student, Harvard School of Dental Medicine, Boston, MA
| | | | - Tiffany H Campbell
- Resident, Department of Dentistry, Massachusetts General Hospital, Boston, MA
| | - Youbai Chen
- Master's Program in Clinical Investigation, Harvard Medical School, Boston, MA
| | - Meredith August
- Associate Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
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Souza LCD, Lopes FF, Bastos EG, Alves CMC. Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report. ACTA ACUST UNITED AC 2018; 40:82-85. [PMID: 29796582 PMCID: PMC6533965 DOI: 10.1590/1678-4685-jbn-3812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
Chronic renal patients are more susceptible to hospital complications and
infections such as urinary tract infections, peritonitis, surgery infections,
and bacteremia, which are often caused by Pseudomonas
aeruginosa. A case of a HIV-positive girl with chronic kidney
disease and with serious oral lesions due to P. aeruginosa
septic shock is presented. The patient showed necrotic lesions in the oral
mucosa, pathological tooth mobility, bone loss, and hematogenous osteomyelitis
in the maxilla. The patient was submitted to systemic antibiotic therapy based
on screening culture and treatment of bone lesions by eliminating the causal
agent and restoring health conditions. This case report is extremely important
for health professionals, since the oral cavity can be affected by this pathogen
or serve as a colonization site.
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30
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Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient. Case Rep Dent 2017; 2017:9525893. [PMID: 28469945 PMCID: PMC5392388 DOI: 10.1155/2017/9525893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022] Open
Abstract
Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.
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Osteomyelitis of the Mandibular Condyle: A Report of 2 Cases With Review of the Literature. J Oral Maxillofac Surg 2016; 75:322-335. [PMID: 27649464 DOI: 10.1016/j.joms.2016.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 11/22/2022]
Abstract
In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible more often than not is odontogenic in origin and the dentate part is usually affected. In this context, involvement of the condyle and coronoid processes is very rare. This report describes 2 unique cases of condylar involvement with osteomyelitis. In these cases, the etiologies were unknown and were successfully managed by condylectomy and antibiotics. A comprehensive review of the English-language literature showed only 18 cases of osteomyelitis of the condyle. Odontogenic, otologic, and tubercular causes were the most common causes of osteomyelitis of the condyle. Radiologically, the condyle usually appeared osteolytic and eroded in osteomyelitis and radionucleotide scans were helpful in localizing the inflammation site. In most cases, condylectomy with appropriate antibiotics was required to eliminate the disease.
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Osteomyelitis-Induced Sequester of Bovine-Derived Bone Mineral/Host Bone Composite 8 Years Post-Sinus Graft: A Case Report. IMPLANT DENT 2016; 25:552-5. [PMID: 27356197 DOI: 10.1097/id.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sinus grafts are a safe and predictable treatment for increasing bone volume in the posterior maxilla. Common complications include membrane perforations and postoperative infection. Little is published with regard to late-onset infection except as it relates to periimplantitis. This report presents a case of late sequestration of bovine bone mineral graft fully consolidated within host lamellar bone, 8 years postsinus lift. Histology revealed mature lamellar bone encapsulating well-integrated particles of bovine bone material with evidence of devitalization and marrow spaces filled with a dense neutrophil infiltrate and a filamentous mixed microbial flora. RESULT A histological diagnosis of osteomyelitis was given on analysis of the integrated bovine bone mineral sequester, 8 years after successful integration and functional loading. CONCLUSIONS It can be concluded from this case report that there is a potential for breakdown and sequestration of bovine bone mineral/host bone composite grafts long after successful integration and consolidation.
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Renapurkar S, Pasternack MS, Nielsen GP, Kaban LB. Juvenile Mandibular Chronic Osteomyelitis: Role of Surgical Debridement and Antibiotics. J Oral Maxillofac Surg 2016; 74:1368-82. [PMID: 26921614 DOI: 10.1016/j.joms.2016.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To document outcomes of management of juvenile mandibular chronic osteomyelitis (JMCO) using a standardized treatment protocol including open biopsy, decortication, microbial culture, and long-term antibiotic therapy. MATERIALS AND METHODS This was a retrospective case study of pediatric patients with JMCO treated at Massachusetts General Hospital for Children from 1996 through 2014. Inclusion criteria included age younger than 18 years, diagnosis of JMCO, management by the protocol, adequate clinical and radiographic data in the record, and follow-up of at least 1 year after initial treatment. Inpatient and outpatient records were reviewed for demographics, clinical and radiographic findings, and histologic and laboratory evaluations. The predictor variable was the standardized treatment protocol and the primary outcome variables were disease status at end of treatment and complications of treatment. RESULTS Twenty patients (mean age at onset, 10.7 yr; range, 3 to 14 yr) were treated, 12 (11 girls) of whom met the inclusion criteria. Management of all patients consisted of biopsy (extraoral when feasible, n = 9; intraoral, n = 3), decortication, cultures, and long-term antibiotic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered only as needed for pain control. There was complete resolution of osteomyelitis with no recurrence in 7 of 12 patients (mean follow-up, 4.3 yr; range, 1 to 11 yr). Five patients had partial responses, with decreased frequency and severity of disease recurrence. These were well controlled with short courses of antibiotics (4 to 12 weeks) with NSAIDs only as needed for pain control (mean follow-up, 1.4 yr; range, 1 to 3 yr). There were no major complications related to antibiotic therapy. Minor complications included rash (n = 2), nausea and vomiting (n = 1), and vaginal candidiasis (n = 1). CONCLUSION The results of this study indicate that 58.3% of patients were cured and had no recurrent symptoms (mean follow-up, 4.3 yr). The remaining patients continue on intermittent treatment with antibiotics for recurrent episodes of swelling and pain. Favorable responses to antibiotic therapy support the hypothesis that JMCO is an infectious disease and that negative cultures might represent a failure of standard culture techniques to isolate the responsible organisms.
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Affiliation(s)
- Shravan Renapurkar
- Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
| | - Mark S Pasternack
- Associate Professor and Unit Chief, Pediatric Infectious Disease, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - G Petur Nielsen
- Associate Professor, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Leonard B Kaban
- Walter C. Guralnick Distinguished Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Massachusetts General Hospital for Children, Harvard School of Dental Medicine, Boston, MA.
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A Case of SAPHO Syndrome with Endodontic Implications and Treatment with Biologic Drugs. J Endod 2015; 41:1565-70. [DOI: 10.1016/j.joen.2015.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 04/06/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022]
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Antimicrobial photodynamic inactivation of Staphylococcus aureus biofilms in bone specimens using methylene blue, toluidine blue ortho and malachite green: An in vitro study. Arch Oral Biol 2015; 60:675-80. [DOI: 10.1016/j.archoralbio.2015.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/14/2015] [Accepted: 02/08/2015] [Indexed: 11/18/2022]
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Voss PJ, Stoddart MJ, Bernstein A, Schmelzeisen R, Nelson K, Stadelmann V, Ziebart T, Poxleitner PJ. Zoledronate induces bisphosphonate-related osteonecrosis of the jaw in osteopenic sheep. Clin Oral Investig 2015; 20:31-8. [PMID: 25843053 DOI: 10.1007/s00784-015-1468-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Bisphosphonate-related osteonecrosis of the jaw (BP-ONJ) occurs in 1 % of patients with medication-induced osteoporosis treated with bisphosphonates. Sheep are an established large animal model for investigating osteoporotic skeletal changes. Zoledronate significantly reduces tissue mineral variability in ovariectomized sheep. The aim of this study was to analyze bone healing after tooth extraction in sheep with induced osteopenia and zoledronate administration. MATERIALS AND METHODS Eight adult ewes were randomly divided into two groups of four animals. All sheep underwent ovariectomy and a low-calcium diet. Dexamethasone was administered weekly for 16 weeks. Zoledronate was then given every third week for a further 16 weeks in four sheep; these infusions were repeated after extraction of two lower premolars. Four sheep without zoledronate administrations served as controls. RESULTS Due to general health conditions, two sheep of the zoledronate group had to be excluded before surgery. The remaining two sheep of this group developed BP-ONJ lesions at the extraction site and various other sites in both jaws. Control group animals showed uneventful wound healing. Histology of the alveolar processes as well as lumbar spine revealed larger portions of old bone and smaller portions of new bone in the zoledronate group. CONCLUSIONS This animal study showed uneventful wound healing after tooth extraction in osteopenic sheep whereas zoledronate treatment leads to development of BP-ONJ-like lesions. CLINICAL RELEVANCE As bisphosphonate administration is a standard treatment for glucocorticoid-induced osteoporosis, this model can be used for further research in pathogenesis and management of bisphosphonate-related adverse events.
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Affiliation(s)
- Pit J Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Martin J Stoddart
- AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
| | - Anke Bernstein
- Department of Orthopedics and Traumatology, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Rainer Schmelzeisen
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Vincent Stadelmann
- AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Philipp J Poxleitner
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. .,AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos, Switzerland.
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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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Kodama Y, Tanaka R, Kurokawa A, Ohnuki H, Sultana S, Hayashi T, Iizuka T, Takagi R. Severe destruction of the temporomandibular joint with complete resorption of the condyle associated with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e128-33. [PMID: 23664782 DOI: 10.1016/j.oooo.2013.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/26/2013] [Accepted: 03/06/2013] [Indexed: 11/16/2022]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome consists of a combination of inflammatory bone disorders and dermatologic pathology. Bone lesions as a form of diffuse sclerosing osteomyelitis in the mandible occur in the posterior body and ramus. Bone lesions rarely spread to the temporomandibular joint (TMJ) where ankylosis may result. Herein we present an unusual case of SAPHO syndrome with TMJ involvement in which severe destruction of the TMJ occurred. We observed an extension of the invasive soft tissue lesion into the infratemporal fossa from the TMJ with complete resorption of the condyle. In contrast to other previously reported cases, in our case the condyle was strongly suspected as the primary site of the bone lesion with subsequent extension to the ramus and infratemporal fossa. The destructive nature and related symptoms resembled a malignant tumor.
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Affiliation(s)
- Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Suei Y. Radiographic findings of bisphosphonate-related osteomyelitis of the jaw: investigation of the diagnostic points by comparison with radiation osteomyelitis, suppurative osteomyelitis, and diffuse sclerosing osteomyelitis. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0135-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Recognition of bisphosphonate-related osteonecrosis of the jaw among oral and maxillofacial radiologists: results from a questionnaire-based survey in Japan. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0114-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reichardt LF, Pitak-Arnnop P, Hemprich A, Dhanuthai K, Pausch NC. Chronic refractory osteomyelitis as a part of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome: a diagnostic challenge. ANZ J Surg 2012; 81:642-3. [PMID: 22295403 DOI: 10.1111/j.1445-2197.2011.05839.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lea Franziska Reichardt
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Scientific Unit for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, University Hospital of Leipzig, Leipzig, Germany
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The SAPHO syndrome--are microbes involved? Best Pract Res Clin Rheumatol 2012; 25:423-34. [PMID: 22100290 DOI: 10.1016/j.berh.2011.01.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/27/2011] [Indexed: 01/18/2023]
Abstract
The syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) includes a rare group of chronic, relapsing, inflammatory osteoarticular disorders that is conventionally associated with manifestations in the skin. Diagnostic dilemmas can arise due to incomplete manifestations or confusion generated through mimicking of other conditions, such as osteomyelitis. The aetiology of this syndrome remains unclear, but probably involves genetic, immunological and infectious mechanisms. The possible pathogenetic role of infectious agents in genetically predisposed individuals, resulting in a 'reactive osteitis', has been suggested because microbes such as Propionibacterium acnes have been recovered from bone biopsy samples. However, this hypothesis has not been demonstrated as yet. Current knowledge with regard to treatment of this syndrome is based on results reported from small case studies and, thus, is still empiric. The use of antibiotics, instituted based on the isolation of Propionibacterium acnes, has been reported to show conflicting results. Promising results for potential future application have recently been reported for treatment of SAPHO with bisphosphonates and antagonists of tumour necrosis factor-α. This review aims to evaluate the existing knowledge on the SAPHO syndrome and to provide information on symptoms, diagnosis and treatment options for this disease.
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Mochizuki Y, Omura K, Hirai H, Kugimoto T, Osako T, Taguchi T. Chronic mandibular osteomyelitis with suspected underlying synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: a case report. J Inflamm Res 2012; 5:29-35. [PMID: 22427727 PMCID: PMC3304341 DOI: 10.2147/jir.s29981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic mandibular osteomyelitis is an intractable disease. In recent years, some case reports have related this disease process to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, which is chronic with frequent remissions and exacerbations. This report describes a case of chronic mandibular osteomyelitis suspected to be SAPHO syndrome. A 68-year-old woman presented with pain on the left side of the mandible. On the basis of clinical and radiological findings, chronic mandibular diffuse sclerosing osteomyelitis was initially diagnosed. We administrated oral clarithromycin (400 mg daily) and levofloxacin (500 mg daily), and her pain subsequently resolved. On (99m)Tc-labeled methylene diphosphonate scintigraphy, tracer uptake in the asymptomatic mandible was unchanged, but there was increasing tracer uptake in the sternocostal and sternoclavicular joints, compared with (99m)Tc-labeled methylene diphosphonate scintigraphic findings of the first visit. We diagnosed SAPHO syndrome and administrated oral sodium risedronate hydrate (2.5 mg daily). Although there has been no pain or swelling in the area of the left mandibular lesion, we have followed up on other skin and osteoarticular manifestations in conjunction with other medical departments.
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Affiliation(s)
- Yumi Mochizuki
- Department of Oral and Maxillofacial Surgery, Oral Restitution, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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A case of SAPHO syndrome with diffuse sclerosing osteomyelitis of the mandible treated successfully with prednisolone and bisphosphonate. J Oral Maxillofac Surg 2011; 70:626-31. [PMID: 21816533 DOI: 10.1016/j.joms.2011.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/08/2011] [Accepted: 04/11/2011] [Indexed: 11/21/2022]
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Theologie-Lygidakis N, Schoinohoriti O, Iatrou I. Surgical management of primary chronic osteomyelitis of the jaws in children: a prospective analysis of five cases and review of the literature. Oral Maxillofac Surg 2011; 15:41-50. [PMID: 20978813 DOI: 10.1007/s10006-010-0248-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 10/11/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Primary chronic osteomyelitis (PCO) of the jaws is an uncommon non-suppurative inflammatory disease of unknown origin. Although the disease is not age-specific, only sparse cases with onset during childhood or adolescence have been reported in the literature. PURPOSE This study seeks to present five cases of maxillofacial PCO in children and to evaluate the effectiveness of the applied therapeutic protocol. A review of the literature concerning diagnosis and treatment of PCO with special emphasis on surgical therapy is also performed. PATIENTS AND METHODS Demographic data, clinical, radiographic and histopathologic findings, blood tests results, and the treatment protocol applied to five young patients suffering from PCO and referred to the Department of Oral and Maxillofacial Surgery at "A. & P. Kyriakou Children's Hospital" over the past 5 years are presented. Decortication and contouring of the affected bone were performed; antibiotics were administered for a short period of time and the patients remained under follow-up evaluation. RESULTS The posterior mandible was affected in four cases and the maxilla-zygomatic bone in one case. All patients showed remission of signs and symptoms after surgical treatment. The postsurgical clinical course was uneventful in all cases. However, recurrences have been noted, as reported in the literature. CONCLUSION PCO of the jaws is a complex clinical entity, presenting both a diagnostic and therapeutic challenge, especially in young patients. Surgical treatment in conjunction with antibiotics and non-steroid anti-inflammatory drugs proved to be beneficial and to improve considerably the patients' quality of life. Nevertheless, exacerbation of the disease may appear and regular follow-up of the patients is required.
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Affiliation(s)
- Nadia Theologie-Lygidakis
- University Department of Oral and Maxillofacial Surgery, A. & P. Kyriakou Children's Hospital, Dental School, University of Athens, Athens, Greece.
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SAPHO syndrome with affection of the mandible: diagnosis, treatment, and review of literature. ACTA ACUST UNITED AC 2010; 111:190-5. [PMID: 20674419 DOI: 10.1016/j.tripleo.2010.04.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 11/23/2022]
Abstract
The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare syndrome of unknown etiology. Involvement of the mandible is found in almost 10% of cases. In the literature, conservative treatment is recommended most often, because decortication and partial resection are found to be ineffective and of temporary profit. We report a case of SAPHO syndrome in a 44-year-old women with unilateral hyperostosis of the mandible and massive painful swelling of the surrounding soft tissues. Owing to facial disfiguration and pain, resection of the affected bone followed by immediate reconstruction with a microvascular iliac crest flap were performed. The aim of this paper was to present the necessity of surgical intervention in SAPHO syndrome of the mandible in cases of esthetic and functional limitation.
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Yanamoto S, Kawasaki G, Yoshitomi I, Mizuno A. Diffuse chronic sclerosing osteomyelitis of the mandible with synovitis, acne, pustulosis, hyperostosis, and osteitis: report of a long-term follow-up case. J Oral Maxillofac Surg 2010; 68:212-7. [PMID: 20006181 DOI: 10.1016/j.joms.2009.04.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 04/24/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Souichi Yanamoto
- Department of Oral and Maxillofacial Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan.
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Utumi ER, Oliveira Sales MA, Shinohara EH, Takahashi A, Coracin FL, Rocha RG, Paraíso Cavalcanti MG. SAPHO syndrome with temporomandibular joint ankylosis: clinical, radiological, histopathological, and therapeutical correlations. ACTA ACUST UNITED AC 2008; 105:e67-72. [PMID: 18280950 DOI: 10.1016/j.tripleo.2007.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 08/30/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
The SAPHO syndrome is characterized by specific clinical manifestations of synovitis, acne pustulosis, hyperostosis, and osteitis. It is a rare disease with a combination of osseous and articular manifestations associated with skin lesions. We describe a patient with SAPHO syndrome of the mandible and involvement of the temporomandibular joint (TMJ ankylosis). The findings from orthopantomography, computed tomography (CT), and clinical and histopathological examinations are compared and analyzed to improve the final diagnosis. Our patient was submitted to a bilateral high condylectomy and coronoidectomy to correct the open mouth limitation. No previous report of SAPHO syndrome associated with secondary TMJ ankylosis was found in the literature.
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Affiliation(s)
- Estevam Rubens Utumi
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Ariji Y, Izumi M, Gotoh M, Naitoh M, Katoh M, Kuroiwa Y, Obayashi N, Kurita K, Shimozato K, Ariji E. MRI features of mandibular osteomyelitis: practical criteria based on an association with conventional radiography features and clinical classification. ACTA ACUST UNITED AC 2008; 105:503-11. [PMID: 17900947 DOI: 10.1016/j.tripleo.2007.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 03/16/2007] [Accepted: 04/25/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aims of this study were (1) to assess the diagnostic power of magnetic resonance imaging (MRI) for mandibular osteomyelitis through comparison with conventional techniques and (2) to establish practical MRI diagnostic criteria in relation to treatment and clinical outcome. STUDY DESIGN In 55 subjects, clinically suspected as mandibular osteomyelitis, signal intensities (SI) were evaluated on T1-weighted/short T1 inversion recovery (STIR) images. RESULTS Forty-seven subjects were definitively diagnosed as having osteomyelitis by pathology studies or clinical course. For the acute or subacute stage, positively associated appearances were low SI on T1-weighted image and extensive high or focal high SI on the STIR image. For chronic stage, appearances of low SI on both T1-weighted and STIR images should be added to those for the acute or subacute stage. These findings support the at-present accepted imaging diagnostic criteria based on bony changes for detection of osteomyelitis. CONCLUSION This study confirms that T1-weighted/STIR images are useful for the detection of mandibular osteomyelitis.
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Affiliation(s)
- Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, Nagoya, Japan.
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Persac S, Péron JM. [Temporal cellulitis of odontogenic origin complicated by temporomandibular osteoarthritis]. ACTA ACUST UNITED AC 2008; 109:110-3. [PMID: 18343469 DOI: 10.1016/j.stomax.2007.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 12/18/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Temporal cellulitis complicated by temporomandibular osteoarthritis and mandibular osteomyelitis is rare with the availability of antibiotics and the prevention of dental infections. CASE REPORT A 56 year-old woman developed a jaw abscess during hospitalization in an intensive care unit following medical drug overdose. Repeatedly surgical drainage was performed guided by CT scans and multiple antibiotherapies. CT scan follow-up revealed temporomandibular arthritis with decrease of the joint space, synovitis, and subchondral cysts. Slow improvement was noted but limited mouth opening was persistent. DISCUSSION This case illustrates the insidious evolution of an uncommon infection. It requires both expert clinical evaluation and an early MRI or CT scan investigation to determine the extension of the infection. Treatment is urgent because of the prognosis and is achieved by surgical drainage and adequate long-term antibiotherapy.
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Affiliation(s)
- S Persac
- Service de chirurgie maxillofaciale et stomatologie, centre hospitalier universitaire Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
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