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Mohamedbhai H, Mamdani S, Compeyrot-Lacassagne S, Saeed N. Collaborative approach to paediatric chronic non-bacterial osteomyelitis of the mandible: Great Ormond Street Hospital case series. Br J Oral Maxillofac Surg 2024; 62:373-377. [PMID: 38599930 DOI: 10.1016/j.bjoms.2023.12.022] [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: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 04/12/2024]
Abstract
This paper outlines a 10-patient case series of chronic non-bacterial osteomyelitis (CNO) of the mandible at a tertiary paediatric hospital in the UK. Our findings highlight the homogeneous presenting signs and symptoms of an intermittently painful, swollen angle and ramus of the mandible. We present the typical laboratory investigative findings (normal inflammatory markers) and imaging appearances (sclerosis and periosteal oedema). Our paper outlines an investigation protocol, including recommendations for extraoral bone biopsies and systemic magnetic resonance imaging (MRI). We explain the importance of multidisciplinary care, with combined care by rheumatologists and infectious disease specialists. Finally we demonstrate the efficacy of our treatment algorithm for oral non-steroidal anti-inflammatory drugs (NSAIDs), and in those cases refractory to NSAIDS, intravenous pamidronate. This paper provides a useful addition to the literature by informing OMF surgeons of this rare condition and given the clinical equipoise in treatments, it can hopefully guide clinicians in an investigation pathway and management protocol.
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Affiliation(s)
| | - Sajida Mamdani
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | | | - Nadeem Saeed
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
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Pappachan B, Agrawal R. Osteomyelitis in Jaw of Children and Young Adults. J Maxillofac Oral Surg 2023. [DOI: 10.1007/s12663-023-01852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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3
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Recurrent osteomyelitis with proliferative periostitis after segmental resection and reconstruction of the mandible: a case report. Oral Maxillofac Surg 2023; 27:163-168. [PMID: 35296946 PMCID: PMC9938053 DOI: 10.1007/s10006-022-01051-4] [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: 12/12/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
A 50-year-old patient presented with a two-year history of chronic osteomyelitis of the left mandibular body. It was treated by wide segmental resection of the left hemimandible and reconstruction with a free vascularized fibular graft. Six months after surgery, the patient returned with pain, swelling, and moth-like lesions in the transplant in combination with appositional bone formation surrounding the ossified fibular bone. Radiographic and histological examination led to the diagnosis of a recurrent osteomyelitis with proliferative periostitis affecting the resected and reconstructed mandible. Application of ibandronate led to a significant symptom decrease.
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Zain‐Alabdeen E, Abdelfattah A, Kordi O, Al‐Sadhan R. The dilemma of juvenile fibrous dysplasia versus chronic osteomyelitis of the posterior mandible: A case report. Clin Case Rep 2022; 10:e6379. [PMID: 36237946 PMCID: PMC9536499 DOI: 10.1002/ccr3.6379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022] Open
Abstract
The clinical and radiographic dilemma of fibrous dysplasia versus osteomyelitis is highlighted in this case of a 4‐year‐old girl with a bony hard swelling in mandibular body and ramus. Rather than relying on histopathological appearance alone, dental professionals should be familiar with the radiographic differences between the two conditions.
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Affiliation(s)
- Ebtihal Zain‐Alabdeen
- Department of Oral Clinical and Basic Sciences, College of DentistryTaibah UniversityAlmadinah AlmunawwarahSaudi Arabia
| | - Ashraf Abdelfattah
- Department of Oral and Maxillofacial surgeryKing Fahad General HospitalAlmadinah AlmunawwarahSaudi Arabia
| | - Osama Kordi
- Department of Oral and Maxillofacial surgeryKing Fahad General HospitalAlmadinah AlmunawwarahSaudi Arabia
| | - Ra’ed Al‐Sadhan
- Department Oral Medicine and Diagnostic SciencesKing Saud UniversityRiyadhSaudi Arabia
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Nakamura A, Hasebe D, Kato Y, Nishiyama H, Hayashi T, Kobayashi T. Intravenous administration of lidocaine and magnesium for severe pain caused by primary chronic osteomyelitis of the mandible: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Johnston DT, Phero JA, Hechler BL. The Necessity of Antibiotics in the Management of Surgically Treated Mandibular Osteomyelitis: A Systematic Review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:11-23. [PMID: 35863960 DOI: 10.1016/j.oooo.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mandibular osteomyelitis remains an incompletely understood entity, and treatment of its various presentations remains diverse. The purpose of this study was to review the necessity of antibiotic therapy after surgical treatment of mandibular osteomyelitis. STUDY DESIGN A systematic review of published articles on surgical management of mandibular osteomyelitis with or without postoperative antibiotic therapy was performed to answer the question, "Does the use of postoperative antibiotics compared with surgery alone alter the success rate in treating mandibular osteomyelitis?" The most recent evidence was sought by searching PubMed, Embase, and Scopus databases. Article appraisal was performed by 2 reviewers. RESULTS Forty-five articles were found that met the inclusion criteria, with all studies being retrospective cohort or case series designs. Only 13 articles used Zurich classification designations of acute osteomyelitis, secondary chronic osteomyelitis, or primary chronic osteomyelitis, and the general heterogeneity of these articles made comparison difficult. No study made an intentional statistical assessment of various antibiotic protocols. CONCLUSIONS Limited evidence suggested that resection may have better success rates than other forms of surgical intervention, regardless of antibiotic therapy. This systematic review questions the perceived necessity of intermediate- or long-term antibiotic therapy in the management of mandibular osteomyelitis after surgical resection.
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Passi S, Gupta J, Mehta A, Verma L. Diagnostic Challenge Involving Diffuse Mandibular Swelling in Mixed Dentition: Use of Cone-beam Radiography. Int J Clin Pediatr Dent 2021; 14:430-433. [PMID: 34720520 PMCID: PMC8543996 DOI: 10.5005/jp-journals-10005-1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim and objective This case report aims to discuss a case of chronic osteomyelitis with proliferative periostitis (COPP) in which cone-beam computed tomography (CBCT) played a key role in the diagnosis and identification of the disease. Background Osteomyelitis is frequently seen in the maxillofacial region, with the mandible being more affected as compared to the maxilla. Chronic osteomyelitis with proliferative periostitis is often seen in children and young adults, which occurs due to the spread of infection from a bacterial focus. Case description A 12-year-old boy presented with a swelling on the right side of the mandible. Extraorally, the swelling appeared diffuse, non-tender, hard on palpation, and was associated with right submandibular lymphadenopathy. Intraorally, a hard bony protrusion was found on the buccal aspect of the edentulous space of the first premolar region obliterating the vestibular depth. It was provisionally diagnosed to be a case of chronic alveolar abscess with respect to deciduous molar, with a suspicion of some underlying bony pathology. Blood investigations showed a raised value of erythrocyte sedimentation rate and alkaline phosphatase. Cone-beam computed tomography examinations showed bony laminations parallel to each other and the underlying cortical bone in the axial and sagittal images and these were present both buccally and lingually. The CBCT descriptions led to the diagnosis of Garre's osteomyelitis in this case which was later confirmed by histopathological examination. Conclusion The detailed imaging as well as the three-dimensional reconstruction of the images has helped to reach out to a differential diagnosis in this case. Clinical significance This case report emphasizes the importance of newer techniques such as CBCT in reaching out at a diagnostic conclusion in challenging clinical cases. How to cite this article Passi S, Gupta J, Mehta A, et al. Diagnostic Challenge Involving Diffuse Mandibular Swelling in Mixed Dentition: Use of Cone-beam Radiography. Int J Clin Pediatr Dent 2021;14(3):430–433.
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Affiliation(s)
- Sidhi Passi
- Department of Pedodontics, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Jyoti Gupta
- Department of Periodontics, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Ajay Mehta
- Department of Radiology, Aarhus Hospital, Denmark
| | - Leena Verma
- Department of Pedodontics, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
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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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Matharu J, Taylor H, Sproat C, Kwok J, Brown J, Patel V. Diffuse sclerosing osteomyelitis: a case series and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:437-446. [DOI: 10.1016/j.oooo.2019.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/17/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
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10
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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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Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible. J Craniomaxillofac Surg 2019; 47:1922-1928. [PMID: 31810841 DOI: 10.1016/j.jcms.2019.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 11/20/2022] Open
Abstract
Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.
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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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13
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Hamrick HJ. Chronic Nonbacterial Osteomyelitis of the Mandible: Recognition, Etiology, and Management. Clin Pediatr (Phila) 2018; 57:475-477. [PMID: 28805072 DOI: 10.1177/0009922817721157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Harvey J Hamrick
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
The complexity of the craniofacial patient mandates the cooperation of a multidisciplinary team that can systematically evaluate each individual and ensure that a protocol-driven pathway is undertaken for the best patient care. Oral and maxillofacial surgeons contribute to surgical care in this setting with specific knowledge of growth and development of the face. This enables optimum timing for early skeletal correction where appropriate, and definitive surgery following the cessation of growth to maximize function and aesthetics. This chapter will describe the major principles in managing patients with specific craniofacial anomalies and provide examples of the outcomes possible.
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Affiliation(s)
- A A Heggie
- Department of Plastic & Maxillofacial Surgery, Royal Children's Hospital of Melbourne, Parkville, Victoria, Australia
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15
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Trends in maxillofacial imaging. Clin Radiol 2017; 73:4-18. [PMID: 28341434 DOI: 10.1016/j.crad.2017.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/23/2017] [Accepted: 02/09/2017] [Indexed: 11/20/2022]
Abstract
Maxillofacial imaging encompasses radiology of the teeth and jaws, including the temporomandibular joints. Modalities used include intra-oral radiographs, panoramic tomography, cephalograms, cone-beam computed tomography, computed tomography, magnetic resonance imaging, ultrasound, and radionuclide imaging. Common indications for imaging are impacted and supernumerary teeth, dental implants, inflammatory dental disease, and fibro-osseous lesions, cysts, and masses of the jaws. Osteonecrosis of the jaws may follow radiotherapy or the use of bisphosphonates and other drugs. Imaging of the temporomandibular joints and the potential role of imaging in obstructive sleep apnoea are also discussed.
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Park J, Myoung H. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2016; 42:215-20. [PMID: 27595089 PMCID: PMC5009196 DOI: 10.5125/jkaoms.2016.42.4.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/16/2016] [Accepted: 03/19/2016] [Indexed: 11/21/2022] Open
Abstract
In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.
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Affiliation(s)
- Joonhyoung Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.; Dental Research Institute, Seoul National University, Seoul, Korea
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Padwa BL, Dentino K, Robson CD, Woo SB, Kurek K, Resnick CM. Pediatric Chronic Nonbacterial Osteomyelitis of the Jaw: Clinical, Radiographic, and Histopathologic Features. J Oral Maxillofac Surg 2016; 74:2393-2402. [PMID: 27318191 DOI: 10.1016/j.joms.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/14/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Chronic nonbacterial osteomyelitis (CNO) is a focal sterile inflammatory osteitis in children that most commonly develops in the long bones, but can occur in any bone. The disease course is variable, ranging from acute and self-resolving isolated lesions to chronic recurrent multifocal osteomyelitis (CRMO), which is frequently associated with extraosseous inflammatory disease. The purpose of this study was to present our clinical experience with CNO of the mandible in children. The specific aims were to 1) document the clinical characteristics, radiographic findings, and histologic features of CNO and 2) determine the percentage of our sample with multifocal disease (CRMO). MATERIALS AND METHODS This is a retrospective case series of patients with mandibular CNO. To be included, patients had to have a mandibular lesion radiographically consistent with osteomyelitis without infection, onset before aged 18 years, and complete records. Medical records were reviewed for history, clinical features, imaging, and pathology. Descriptive data were summarized. RESULTS The sample included 22 patients (13 female and 9 male patients) with disease onset at a mean age of 9.05 ± 2.4 years. On presentation, all patients reported mandibular pain and swelling, and 45% had trismus. All had clinical and/or radiographic findings of multifocal intraosseous disease and/or extraosseous inflammatory lesions. Of the patients, 12 (54%) had a documented family history of autoimmune or autoinflammatory disease and 15 (68%) had elevated erythrocyte sedimentation rates during a flare. Computed tomography scans typically showed expansion of the affected mandible with sclerosis of the medullary space, small foci of poorly defined lytic destruction with a lamellated periosteal reaction, and swollen muscles of mastication. Four distinct histologic features were noted including parallel and interconnected osteoid seams, atypical osteoid, areas of woven bone and hypocellular fibroblastic stroma resembling fibrous dysplasia, and patchy nodular fibrosis. CONCLUSION Pediatric CNO of the mandible has characteristic radiographic and pathologic features and is usually found as one of multiple disease foci in CRMO rather than as an isolated lesion.
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Affiliation(s)
- Bonnie L Padwa
- Associate Professor, Harvard School of Dental Medicine, Oral Surgeon-in-Chief Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
| | - Kelley Dentino
- Research Assistant, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Caroline D Robson
- Associate Professor, Harvard Medical School, Division Chief, Neuroradiology, Department of Radiology, Boston Children's Hospital, Boston, MA
| | - Sook Bin Woo
- Associate Professor, Harvard School of Dental Medicine, Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA
| | - Kyle Kurek
- Assistant Professor, Cummings School or Medicine, University of Calgary, Departments of Pathology and Medical Genetics, Alberta Children's Hospital & Research Institute, Boston, MA
| | - Cory M Resnick
- Instructor, Harvard School of Dental Medicine, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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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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Facial asymmetry associated with a mixed radiolucent-radiopaque change of the maxillofacial bones. J Am Dent Assoc 2014; 145:274-9. [PMID: 24583893 DOI: 10.14219/jada.2013.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Obel G, Krogdahl A, Thygesen T, Godballe C. Juvenile Mandibular Chronic Osteomyelitis: 3 Cases and a Literature Review. J Oral Maxillofac Surg 2013; 71:305-9. [DOI: 10.1016/j.joms.2012.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
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Strobel K, Merwald M, Huellner MW, Bolouri C, Veit-Haibach P, del Sol Pèrez-Lago M, Kuttenberger J. [Importance of SPECT/CT for resolving diseases of the jaw]. Radiologe 2012; 52:638-45. [PMID: 22710990 DOI: 10.1007/s00117-011-2271-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CLINICAL/METHODICAL ISSUE Diseases of the jaw, such as osteomyelitis, condylar hyperactivity and tumors need adequate imaging to evaluate the extension and activity for therapy planning. STANDARD RADIOLOGICAL METHODS Conventional planar scintigraphy, orthopantomography, computed tomography (CT) and magnetic resonance imaging (MRI) can be used for the evaluation of jaw diseases. METHODICAL INNOVATIONS Single photon emission computed tomography/computed tomography (SPECT/CT) provides metabolic and morphologic information in one imaging step and is becoming increasingly more available in larger hospitals. PERFORMANCE The SPECT/CT is superior to planar scintigraphy alone, CT and orthopantomography in the evaluation of the extension and activity of osteomyelitis and jaw tumors. ACHIEVEMENTS In our hospital SPECT/CT has replaced the other imaging modalities in the evaluation of osteomyelitis and condylar hyperactivity. PRACTICAL RECOMMENDATIONS If available SPECT/CT should be performed for the evaluation of osteomyelitis of the jaw.
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Affiliation(s)
- K Strobel
- Institut für Nuklearmedizin und Röntgendiagnostik, Luzerner Kantonsspital, CH-6000, Luzern 16, Schweiz.
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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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Kadom N, Egloff A, Obeid G, Bandarkar A, Vezina G. Juvenile mandibular chronic osteomyelitis: multimodality imaging findings. ACTA ACUST UNITED AC 2011; 111:e38-43. [PMID: 21310348 DOI: 10.1016/j.tripleo.2010.10.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Juvenile mandibular chronic osteomyelitis is a rare entity that predominantly affects children and adolescents, but little is known about the factors that contribute to the recurrent course and eventual resolution of this disease. Here, we describe new findings of soft tissue and mandibular nerve canal involvement. MATERIALS AND METHODS Four patients with mandibular diffuse sclerosing osteomyelitis are presented; all were followed with CT, a few also with MRI and bone scan. We recorded imaging findings of lesion location, pattern of bone formation, presence and evolution of lytic lesions, mandibular nerve, and soft tissue involvement. RESULTS In all patients we found enlargement of the mandibular nerve canal and soft tissue changes on CT and MRI (when available). All patients had ground glass bone patterns in conjunction with lamellated/onion skin new periosteal bone formation on CT, and all patients with follow-up CT had change in lytic lesion locations. CONCLUSION Mandibular nerve canal enlargement, soft tissue abnormalities, and change in location of lytic lesions may represent a diagnostic pattern in mandibular diffuse sclerosing osteomyelitis (Garré) that was not previously entirely recognized as such.
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Affiliation(s)
- Nadja Kadom
- Department of Radiology and Diagnostic Imaging, Children's National Medical Center, Washington, DC 20010, USA.
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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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Frid P, Tornes K, Nielsen Ø, Skaug N. Primary chronic osteomyelitis of the jaw—a microbial investigation using cultivation and DNA analysis: a pilot study. ACTA ACUST UNITED AC 2009; 107:641-7. [DOI: 10.1016/j.tripleo.2009.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 11/08/2008] [Accepted: 01/05/2009] [Indexed: 11/17/2022]
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Hernandez JA, Camacho A, Palacio D, Swischuk LE. Low-grade (often multifocal) osteomyelitis (a diagnostic problem and/or a mimicker of tumor). Emerg Radiol 2005; 11:322-7. [PMID: 16344972 DOI: 10.1007/s10140-005-0423-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 03/18/2005] [Indexed: 10/25/2022]
Affiliation(s)
- J Alberto Hernandez
- Department of Radiology, Children's Hospital, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 775550-036, USA
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Aytaç S, Ozbek S, Kahveci R, Ozgenel Y, Akin S, Ozcan M. Titanium Mesh Fracture in Mandibular Reconstruction. J Craniofac Surg 2005; 16:1120-2. [PMID: 16327566 DOI: 10.1097/01.scs.0000179660.30548.5b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after mandible reconstruction in the literature. We reported a case of a broken titanium mesh after mandible reconstruction.
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Affiliation(s)
- Selçuk Aytaç
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Uludağ University, Bursa, Turkey.
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