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Holmes KR, Holmes RD, Martin M, Murray N. Practical Approach to Radiopaque Jaw Lesions. Radiographics 2021; 41:1164-1185. [PMID: 34086497 DOI: 10.1148/rg.2021200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ©RSNA, 2021.
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Affiliation(s)
- Kenneth R Holmes
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - R Davis Holmes
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - Montgomery Martin
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - Nicolas Murray
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
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Mupparapu M, Shi KJ, Ko E. Differential Diagnosis of Periapical Radiopacities and Radiolucencies. Dent Clin North Am 2020; 64:163-189. [PMID: 31735225 DOI: 10.1016/j.cden.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Periapical pathoses represent changes noted at the apices of teeth within the alveolar process that are suspected on examination, visualized via imaging, and confirmed via histopathology. They can be bone forming or destructive. There are pathologic entities that show both types of changes at the apical regions. These lesions must be identified if they are odontogenic in origin because treatment modalities differ. This article discusses identification of radiopaque and radiolucent lesions noted on radiographs. The common opacities and lucencies are described. When required, advanced imaging is used to depict changes within the bone near the periapical regions of mandibular and maxillary teeth.
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Affiliation(s)
- Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Katherine Jie Shi
- Department of Endodontics, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Eugene Ko
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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Zimmermann C, Stuepp RT, Rath IBDS, Grando LJ, Daniel FI, Meurer MI. Diagnostic Challenge and Clinical Management of Juvenile Mandibular Chronic Osteomyelitis. Head Neck Pathol 2019; 14:842-846. [PMID: 31782116 PMCID: PMC7413939 DOI: 10.1007/s12105-019-01087-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
Juvenile mandibular chronic osteomyelitis (JMCO) is a rare, idiopathic disease of chronic bone inflammation without suppuration, sinus tract formation, or sequestration. As the name suggests, this condition predominately affects children. The few cases of JMCO reported in the literature describe different treatments, and thus a standard therapy protocol has not yet been established. The aim of this paper is to report a clinical case in a 9-year-old girl that was misdiagnosed and unsuccessfully treated for 1 year. After experiencing persistent symptoms, a correct diagnosis was subsequently rendered based on the physical and radiographic examination as well as successful treatment with non-steroidal anti-inflammatory drugs (NSAIDs). The patient received drug therapy followed by periods of remission over a 4 year follow-up period. Diagnosis and treatment of JMCO is a challenge given the rarity and nonspecific signs and symptoms of this condition. Treatment with NSAIDs and regular follow-up is a conservative option for these patients.
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Affiliation(s)
- Caroline Zimmermann
- grid.411237.20000 0001 2188 7235Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, SC Brazil
| | - Rúbia Teodoro Stuepp
- grid.411237.20000 0001 2188 7235Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, SC Brazil
| | - Inês Beatriz da Silva Rath
- grid.411237.20000 0001 2188 7235Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC Brazil
| | - Liliane Janete Grando
- grid.411237.20000 0001 2188 7235Department of Pathology, Federal University of Santa Catarina, Florianópolis, SC Brazil
| | - Filipe Ivan Daniel
- grid.411237.20000 0001 2188 7235Department of Pathology, Federal University of Santa Catarina, Florianópolis, SC Brazil
| | - Maria Inês Meurer
- grid.411237.20000 0001 2188 7235Department of Pathology, Federal University of Santa Catarina, Florianópolis, SC Brazil
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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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van de Meent MM, Pichardo SEC, Rodrigues MF, Verbist BM, van Merkesteyn JPR. Radiographic characteristics of chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: A comparison with chronic suppurative osteomyelitis and osteoradionecrosis. J Craniomaxillofac Surg 2018; 46:1631-1636. [PMID: 30017711 DOI: 10.1016/j.jcms.2018.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022] Open
Abstract
Diffuse sclerosing osteomyelitis (DSO) of the mandible is a poorly understood chronic disease. It is assumed to be a form of chronic osteomyelitis. Other forms of chronic osteomyelitis are chronic suppurative osteomyelitis (CSO) and osteoradionecrosis (ORN). This study aimed to investigate radiographic characteristics of DSO and compare these findings with the radiographic characteristics of CSO and ORN in order to radiographically distinguish these three diseases. In this retrospective study, 33 patients were clinically diagnosed with DSO (13), CSO (6), or ORN (14). The panoramic radiographs, computed tomography images, and magnetic resonance images of these patients were evaluated. Osseous and soft tissue changes were analysed. Patients with DSO showed extensive cortical and medullary sclerosis combined with subperiosteal bone formation, condylar process deformation, and hypertrophy and oedema of the masseter muscle. DSO patients showed no pathological fractures or sequestra, which were observed in patients with CSO and ORN. The radiographic characteristics that differentiate DSO from CSO and ORN include subperiosteal bone formation, condylar process deformation, masticatory muscle changes, and the absence of sequestra and pathological fractures.
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Affiliation(s)
- Marieke M van de Meent
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Sarina E C Pichardo
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Myra F Rodrigues
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Division Neuro-, Head-, and Neck Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Conservative treatment of children with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible. J Craniomaxillofac Surg 2017; 45:1938-1943. [DOI: 10.1016/j.jcms.2017.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/14/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022] Open
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Abstract
RATIONALE Sclerosing osteomyelitis of Garré is a rare condition that occurs most commonly in tubular bones and the mandible. Its nontypical symptoms, low morbidity, and insidious process make its diagnosis difficult at an early stage. In this article, we reported a case of chronic sclerosing osteomyelitis which occurred in flat bone. PATIENT CONCERNS A 53-year-old man was diagnosed with rib sclerosing osteomyelitis of Garré who had an 8-year course of intermittent local pain and swelling, which radiated toward the left side of his chest wall. Chest computed tomography (CT) showed irregular sclerosis of the diaphysis of the 10th rib, with periosteal reaction and narrowing of the medullary cavity, and magnetic resonance imaging (MRI) showed T2 heterogeneous low-signal intensity over the 10th rib. DIAGNOSES Based on the features of the clinical signs and radiography and biopsy of the lesion, diagnosis of rib sclerosing osteomyelitis of Garré was made. INTERVENTIONS The patient was treated with surgical excision of a 10-cm-long lesion after failed conservative treatment. OUTCOMES Postoperatively, the patient achieved good functional recovery at the 10-year follow-up. LESSONS Rib sclerosing osteomyelitis of Garré is an unusual condition and represents a noninfective course in the rib with a low morbidity. The surgical management was successful in relieving the patient's symptom.
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Endoscopically-assisted operations in the treatment of odontogenic peripheral osteomyelitis of the posterior mandible. Br J Oral Maxillofac Surg 2016; 54:542-6. [DOI: 10.1016/j.bjoms.2016.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/17/2016] [Indexed: 11/23/2022]
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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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Abstract
Autoinflammatory bone disease is a new branch of autoinflammatory diseases caused by seemingly unprovoked activation of the innate immune system leading to an osseous inflammatory process. The inflammatory bone lesions in these disorders are characterized by chronic inflammation that is typically culture negative with no demonstrable organism on histopathology. The most common autoinflammatory bone diseases in childhood include chronic nonbacterial osteomyelitis (CNO), synovitis, acne, pustulosis, hyperostosis, osteitis syndrome, Majeed syndrome, deficiency of interleukin-1 receptor antagonist, and cherubism. In this article, the authors focus on CNO and summarize the distinct genetic autoinflammatory bone syndromes.
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Affiliation(s)
- Sara M Stern
- Division of Immunology, Rheumatology, and Allergy, Department of Pediatrics, University of Utah, PO Box 581289, Salt Lake City, UT 84158, USA.
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Abstract
Despite recent advances in the understanding of the natural history and molecular abnormalities, many questions remain surrounding the progression and management of fibrous dysplasia (FD). In the absence of comorbidities, the expected behavior of craniofacial FD (CFD) is to be slow growing and without functional consequence. Understanding of the pathophysiologic mechanisms contributing to the various phenotypes of this condition, as well as the predictors of the different behaviors of FD lesions, must be improved. Long-term follow-up of patients with CFD is vital because spontaneous recovery is unlikely, and the course of disease can be unpredictable.
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Affiliation(s)
- Pat Ricalde
- St Joseph's Craniofacial Center, 4200 North Armenia Avenue, Suite 3, Tampa, FL 33607, USA.
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