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Yahara H, Yanamoto S, Takahashi M, Hamada Y, Asaka T, Kitagawa Y, Moridera K, Noguchi K, Maruoka Y, Yahara K. Shotgun metagenomic analysis of saliva microbiome suggests Mogibacterium as a factor associated with chronic bacterial osteomyelitis. PLoS One 2024; 19:e0302569. [PMID: 38709734 PMCID: PMC11073694 DOI: 10.1371/journal.pone.0302569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Osteomyelitis of the jaw is a severe inflammatory disorder that affects bones, and it is categorized into two main types: chronic bacterial and nonbacterial osteomyelitis. Although previous studies have investigated the association between these diseases and the oral microbiome, the specific taxa associated with each disease remain unknown. In this study, we conducted shotgun metagenome sequencing (≥10 Gb from ≥66,395,670 reads per sample) of bulk DNA extracted from saliva obtained from patients with chronic bacterial osteomyelitis (N = 5) and chronic nonbacterial osteomyelitis (N = 10). We then compared the taxonomic composition of the metagenome in terms of both taxonomic and sequence abundances with that of healthy controls (N = 5). Taxonomic profiling revealed a statistically significant increase in both the taxonomic and sequence abundance of Mogibacterium in cases of chronic bacterial osteomyelitis; however, such enrichment was not observed in chronic nonbacterial osteomyelitis. We also compared a previously reported core saliva microbiome (59 genera) with our data and found that out of the 74 genera detected in this study, 47 (including Mogibacterium) were not included in the previous meta-analysis. Additionally, we analyzed a core-genome tree of Mogibacterium from chronic bacterial osteomyelitis and healthy control samples along with a reference complete genome and found that Mogibacterium from both groups was indistinguishable at the core-genome and pan-genome levels. Although limited by the small sample size, our study provides novel evidence of a significant increase in Mogibacterium abundance in the chronic bacterial osteomyelitis group. Moreover, our study presents a comparative analysis of the taxonomic and sequence abundances of all genera detected using deep salivary shotgun metagenome data. The distinct enrichment of Mogibacterium suggests its potential as a marker to distinguish between patients with chronic nonbacterial osteomyelitis and chronic bacterial osteomyelitis, particularly at the early stages when differences are unclear.
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Affiliation(s)
- Hiroko Yahara
- Genome Medical Science Project, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Souichi Yanamoto
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Miho Takahashi
- Department of Oral and Maxillofacial Surgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yuji Hamada
- Department of Oral and Maxillofacial Surgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takuya Asaka
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Kuniyasu Moridera
- Department of Oral and Maxillofacial Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Kazuma Noguchi
- Department of Oral and Maxillofacial Surgery, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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Park YY, Park B. Aesthetic Mandibular Angloplasty to Improve Patient Quality of Life in Chronic Recurrent Multifocal Osteomyelitis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5718. [PMID: 38596579 PMCID: PMC11000766 DOI: 10.1097/gox.0000000000005718] [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: 01/20/2024] [Accepted: 02/14/2024] [Indexed: 04/11/2024]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoimmune disease that typically develops during adolescence and primarily affects women. CRMO primarily targets the bone in arms and legs, with sporadic occurrences in the mandible. CRMO is typically managed with medical treatment, and the efficacy of surgery remains controversial. Complications of surgery include massive bleeding and potential flare-up of CRMO symptoms. Herein, we report a patient with CRMO who had lesions in the bilateral rami of the mandible treated with aesthetic mandibular angloplasty. This is the first case of aesthetic mandibular angloplasty in a patient with CRMO who had bilateral rami involvement of the mandible. The patient began experiencing jaw pain accompanied by swelling and throbbing discomfort beneath the jawline at the age of 10. A pediatrician diagnosed CRMO, and the symptoms were controlled with nonsteroidal antiinflammatory drugs and immunosuppressants (infliximab, adalimumab). Aesthetic mandibular angloplasty was performed at our center because of mandibular hypertrophy. This procedure necessitated considerable removal of the spongy bone, raising concerns about potential massive intraoperative bleeding. Approximately 1.5 cm of the mandibular body was excised to reveal the cortical bone. Bleeding during surgery was not severe, rendering blood transfusions unnecessary. The patient was satisfied with the surgical results. This case indicates the feasibility of angloplasty for such cases.
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Affiliation(s)
- Yun Yong Park
- From the Departments of Plastic and Reconstructive Surgery, iWELL Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Bumjin Park
- From the Departments of Plastic and Reconstructive Surgery, iWELL Plastic Surgery Clinic, Seoul, Republic of Korea
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3
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Choi S, Kim MJ, Kang SH, Park IW. Pediatric mandibular chronic nonbacterial osteomyelitis: A case report with 12 years of radiologic follow-up. Imaging Sci Dent 2024; 54:93-104. [PMID: 38571777 PMCID: PMC10985518 DOI: 10.5624/isd.20230189] [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: 08/31/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 04/05/2024] Open
Abstract
Chronic nonbacterial osteomyelitis (CNO) is histologically characterized by nonspecific osteitis. This inflammatory disorder, which lacks an infectious origin, typically presents with chronic pain and swelling at the affected site that can persist for months or even years. However, it is rare for CNO to affect the mandible. A 10-year-old girl presented with a primary complaint of pain in her left mandible. She had no significant medical or dental history. On examination, swelling was visible on the left buccal side, and imaging revealed radiolucent bone deterioration within the left mandible. This case report presents the radiological changes observed over a 12-year follow-up period. Variations in radiopacity, radiolucency, and periosteal reactions were noted periodically. This case highlights the radiological characteristics and findings that are crucial for the diagnosis of CNO, a condition for which no clear diagnostic criteria are currently available.
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Affiliation(s)
- Sehyun Choi
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min-Ji Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - In-Woo Park
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
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4
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Rosen AS, Sarmiento HL, Rosen PS, Peters SM. Multifocal mixed radiolucent-radiopaque lesions in an adult. J Am Dent Assoc 2024; 155:184-188. [PMID: 36543654 DOI: 10.1016/j.adaj.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
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5
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Zhang Y, Luo Y, Ruan Y, Qian X, Feng Z. Relapse of Low Back Pain After Internal Lumbar Fixation Was Diagnosed with SAPHO Syndrome: A Case Report. Int Med Case Rep J 2023; 16:591-598. [PMID: 37789833 PMCID: PMC10542113 DOI: 10.2147/imcrj.s402752] [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: 01/19/2023] [Accepted: 04/27/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Early diagnosis of SAPHO syndrome is easily confused with other common spine-related diseases and infections. There is currently no consensus regarding the diagnosis of SAPHO syndrome, and specific treatments are empirical because of its rarity. Case Presentation A 62-year-old woman was referred to our department with complaints of low back and lower extremity pain for 2 years, 1.5 years after lumbar spine surgery, and recurrent low back pain for 1 year. Laboratory test results revealed elevated hs-CRP levels and erythrocyte sedimentation rate. Combined with her surgical history and lumbar CT results, adjacent segment degeneration (ASD) was first considered. NSAIDs, analgesics, and supplemental therapies were also administered. However, the patient's symptoms were not significantly relieved. During re-examination, hyperkeratosis with active pustulosis was observed on the patient's palms. Osteitis of the left sacroiliac joint was revealed on imaging. Skeletal ECT revealed a typical "horn sign". The patient was diagnosed with SAPHO syndrome. Based on the original treatment, sulfasalazine enteric-coated tablets, adalimumab (a biological agent of TNF-α), pregabalin, and tramadol sustained-release tablets were administered. The patient reported that her pain was significantly relieved. He was discharged from the hospital and received adalimumab treatment (40 mg once per fortnight in the first 6 months and 40 mg once per month after month 6) in the outpatient clinic. The hyperkeratosis with active pustulosis on both palms fully recovered after 12 months of treatment. The patient was followed up 6 months after full recovery, and no recurrence was found in the symptoms of low back and lower extremity pain and palmar hyperkeratosis with active pustulosis. Conclusion SAPHO syndrome should be suspected in patients present with osteoarticular and/or dermatological manifestations. Biological agents can be used to treat patients with refractory SAPHO syndrome.
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Affiliation(s)
- Yanfeng Zhang
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Yujia Luo
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Yachao Ruan
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
| | - Xiang Qian
- Stanford University School of Medicine Pain Management Center, Redwood City, CA, 94063, USA
| | - Zhiying Feng
- Department of Pain Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People’s Republic of China
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Sergi CM, Miller E, Demellawy DE, Shen F, Zhang M. Chronic recurrent multifocal osteomyelitis. A narrative and pictorial review. Front Immunol 2022; 13:959575. [PMID: 36072576 PMCID: PMC9441751 DOI: 10.3389/fimmu.2022.959575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic recurrent and multifocal osteomyelitis (CRMO) is a nonsporadic autoinflammatory disorder. Currently, it is diagnosed based on clinical, radiologic, pathological, and longitudinal data. Numerous aspects should be highlighted due to increased knowledge in imaging and immunology. We emphasize the use of whole-body MRI, which is a non-invasive diagnostic strategy. A literature review was carried out on longitudinal studies. Commonly, the mean age at diagnosis is 11 years, ranging between 3 and 17. The most common sites are the long bone metaphysis, particularly femoral and tibial metaphysis. In addition, the pelvis, spine, clavicle, and mandible may be involved. In long bones, the radiologic appearance can show typical structure, mixed lytic and sclerotic, sclerotic or lytic. It is frequently metaphyseal or juxta-physeal, with hyperostosis or periosteal thickening. The involvement of the vertebral skeleton is often multifocal. Therefore, whole-body MRI is essential in identifying subclinical lesions. CRMO is a polymorphic disorder in which whole-body MRI is beneficial to demonstrate subclinical edema. Vertebral collapse requires long-term monitoring.
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Affiliation(s)
- Consolato M. Sergi
- Anatomic Pathology Division, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Consolato M. Sergi,
| | - Elka Miller
- Medical Imaging Department, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada
| | - Dina El Demellawy
- Anatomic Pathology Division, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Fan Shen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Mingyong Zhang
- Department of Orthopedics, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
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Waldman S, Shimonov M, Yang N, Spielman D, Godfrey KJ, Dean KE, Phillips CD, Helman SN. Benign bony tumors of the paranasal sinuses, orbit, and skull base. Am J Otolaryngol 2022; 43:103404. [PMID: 35246319 DOI: 10.1016/j.amjoto.2022.103404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
Abstract
Benign bony tumors of the skull base and paranasal sinuses are uncommon entities, with an overall higher incidence in males. Benign bony tumors may lead to local expansion with resultant mass effect of potentially critical structures. Some benign bony tumors may undergo malignant transformation. This article reviews the presentation and management of benign bone tumors of the skull base and paranasal sinuses with special consideration to involvement of the adjacent orbit, intracranial and critical neurovascular structures. This review covers tumor incidence, location, gross and histologic appearance as well as radiographic findings, treatment, and recurrence rates. Tumors discussed in this article include osteochondromas, osteomas, osteoid osteomas, aneurysmal bone cysts, fibrous dysplasia, giant cell tumors, cemento-ossifying fibroma, ameloblastic fibro-odontoma, ecchordosis physaliphora, chondromyxoid fibroma, primary chronic osteomyelitis, primary chronic osteomyelitis, osteochondromyxoma, and dense bone islands.
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Affiliation(s)
- Spencer Waldman
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Menachem Shimonov
- SUNY Downstate, College of Medicine, 450 Clarkson Ave, Brooklyn, NY 11203, United States of America.
| | - Nathan Yang
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Daniel Spielman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
| | - Kyle J Godfrey
- Weill Cornell Medical College, Department of Ophthalmology--1305 York Ave, 12(th) Floor New York, NY 10021, United States of America.
| | - Kathryn E Dean
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - C Douglas Phillips
- Weill Cornell Imaging at New York-Presbyterian 1305 York Avenue,3rd Floor, New York, NY 10021, United States of America.
| | - Samuel Nathaniel Helman
- Weill Cornell Medical College, Department of Otolaryngology - Head and Neck Surgery, 2315 Broadway, 3rd Floor, New York, NY 10024, United States of America.
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Baggett K, Brandon TG, Xiao R, Valenzuela Z, Buckley LH, Weiss PF. Incidence Rates of Psoriasis in Children with Inflammatory Bowel Disease and Juvenile Arthritis Treated with TNFi Agents and DMARDs. J Rheumatol 2022; 49:935-941. [DOI: 10.3899/jrheum.211359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/22/2022]
Abstract
Objective To estimate the differential effect of tumor necrosis factor inhibitor (TNFi) therapies and presence/absence of conventional synthetic disease-modifying antirheumatic drug (DMARD) on the incidence of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic nonbacterial osteomyelitis (CNO). Methods This was a retrospective cohort study from 2008 to 2020. TNFi and DMARD exposures were dichotomized as ever/never. The primary outcome was incident psoriasis. Incidence rates (IRs) of psoriasis were stratified by underlying diagnosis, TNFi agent, and DMARD use. Poisson regression was used to assess the IR ratios (IRR) between exposure groups. Results 5088 children met inclusion criteria – 3794 (75%) had IBD, 1189 (23%) had JIA, and 105 (2%) had CNO. 613 (30%) and 1410 (70%) had TNFi exposure with or without a DMARD, respectively. IRR of developing psoriasis in patients exposed to adalimumab was 2.70 times higher (95% CI: 1.52-4.75; p<0.001) than those who did not receive any TNFi treatment, when controlling for DMARD, sex, and family history of psoriasis. IRR was lower, but not significantly different, for patients exposed to infliximab (IRR=2.34; 95% CI: 1.56-3.51; p<0.001) and etanercept (IRR=2.22; 95% CI: 1.17-4.21; p=0.006) compared to TNFi unexposed patients. IRR of TNFi exposure was lower by 0.25 (p<0.001) in DMARD exposed patients compared to non- DMARD exposed patients. Conclusion IRR of TNFi-induced psoriasis was not significantly different amongst adalimumab, infliximab, and etanercept. However, for patients with exposure to any of the TNFi evaluated, the IRR was significantly lower in those also exposed to a DMARD.
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Díaz-Castellón DF, Llaguno-Rubio JM, Medina-Ocampo PE. [Imaging features of osteomyelitis of the jaws with different diagnostic methods. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e077. [PMID: 38464859 PMCID: PMC10919801 DOI: 10.21142/2523-2754-0903-2021-077] [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: 08/21/2021] [Accepted: 09/24/2021] [Indexed: 03/12/2024] Open
Abstract
Osteomyelitis of the jaws (OM) is an infectious pathology involving the bone marrow. It is due to various etiologies, the main one being odontogenic. The diagnosis of OM is a challenge for dentists, who must rely on clinical and imaging examinations. Panoramic radiography is the most frequently used imaging test, but it has some limitations that have improved with the incorporation of new imaging methods such as computed tomography, cone beam computed tomography, magnetic resonance imaging, and bone scintigraphy with radionuclides. The purpose of this review was to describe the imaging characteristics of OM of the jaws according to the radiological diagnostic methods available in the literature in order to provide radiologisst with greater knowledge and improve reporting in daily practice.
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Affiliation(s)
- Dirce Fernanda Díaz-Castellón
- Facultad de Odontología de la Universidad San Francisco Xavier de Chuquisaca. Sucre, Bolivia. Facultad de Odontología Universidad San Francisco Xavier de Chuquisaca Sucre Bolivia
| | - Jhoana Mercedes Llaguno-Rubio
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
| | - Paola Eliana Medina-Ocampo
- División de Radiología Bucal y Maxilofacial de la Universidad Científica del Sur. Lima, Perú. , Universidad Científica del Sur División de Radiología Bucal y Maxilofacial Universidad Científica del Sur Lima Peru
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Robertsson C, Sävendahl L, Cardemil C. Primary chronic osteomyelitis of the jaw: Rapid improvement after hormonal suppression in a girl with precocious puberty. Bone Rep 2021; 14:101089. [PMID: 34026952 PMCID: PMC8131392 DOI: 10.1016/j.bonr.2021.101089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/09/2021] [Accepted: 05/01/2021] [Indexed: 11/11/2022] Open
Abstract
Primary chronic osteomyelitis (PCO) of the jaw is a non-infectious, inflammatory state of the jawbone of unknown etiology. In recurrent periods, these patients often exhibit swelling of the cheek, impaired ability to open their mouth as well as pain. Available treatments today include anti-inflammatory or antiresorptive drugs, hyperbaric oxygen, surgical decortication or resection followed by reconstruction where none of them have been described to lead to restored anatomy and complete relief of symptoms. We here report the unexpected complete regression of all clinical symptoms of PCO within three months after initiating pubertal suppression therapy with a gonadotropin-releasing hormone analogue in a 9-year-old girl with PCO of the jaw and early onset of pubertal development. Radiology of the jawbone confirmed complete PCO remission when performed 18 months after starting the hormone suppression therapy. To our knowledge, total regression of PCO in such a short period of time has not been described earlier suggesting an effect of the anti-hormonal therapy per se. In this case report, we discuss possible underlying mechanisms and hypothesize that anti-hormonal treatment could be a potential effective treatment in patients with PCO of the jaw.
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Affiliation(s)
- Caroline Robertsson
- Unit of Cranio- & Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Sävendahl
- Unit of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Carina Cardemil
- Unit of Cranio- & Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Abstract
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare clinical entity involving musculoskeletal and dermatologic systems. Its main features are prominent inflammatory cutaneous and articular manifestations. Anterior chest wall pain, more commonly at sternoclavicular and sternocostal joints, along with palmoplantar pustulosis and acne can point to this uncommon syndrome. Here, we report a case of a 15-year-old female, who presented with swelling at the anterior chest wall, was referred for the bone scan. Bone scintigraphy and single-photon emission computed tomography (SPECT/CT) detected classical “bull-head” sign, and further physical examination, for skin lesions, confirmed the diagnosis.
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Affiliation(s)
- Nitin Gupta
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritu Verma
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ethel Shangne Belho
- Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
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12
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Mudalal M, Sun XL, Li X, Fang J, Qi ML, Wang J, Du LY, Zhou YM. Minimally invasive endoscopic maxillary sinus lifting and immediate implant placement: A case report. World J Clin Cases 2019; 7:1234-1241. [PMID: 31183358 PMCID: PMC6547315 DOI: 10.12998/wjcc.v7.i10.1234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This case report discusses a modified approach for maxillary sinus augmentation, in which platelet-rich fibrin, endoscope, simultaneous implant placement, and sinus floor elevation (PESS) were applied for a maxillary sinus floor lift in a 40-year-old patient.
CASE SUMMARY A 40-year-old woman suffered missing upper right first molar. Implant stability quotient and cone-beam computed tomography (CBCT) were used to evaluate the diagnosis. CBCT showed insufficient posterior maxillary bone with a mean residual alveolar bone height of only 3.5 mm. The patient underwent a minimally invasive sinus floor elevation endoscopically. The sinus membrane was elevated in two stages, and a 12-mm implant was placed immediately. At 3 mo postoperatively, the final impressions were accomplished, and a full-ceramic crown was fit-placed. A 6-mo follow-up demonstrated satisfactory aesthetic and functional results.
CONCLUSION This is the first report to use an endoscope for maxillary sinus floor lifting in cases with severe and insufficient bone height. This case report demonstrates the advantages of the PESS technique, which include minimal invasiveness with high precision, being applicable in cases with a residual alveolar bone height < 4 mm with a promising result, and a shortened treatment period from 12 to 3 mo.
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Affiliation(s)
- Mahmoud Mudalal
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Lin Sun
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Xue Li
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Jiao Fang
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Man-Lin Qi
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Jia Wang
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Liu-Yi Du
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
| | - Yan-Min Zhou
- Department of Dental Implantology, School and Hospital of Stomatology, Jilin University, Changchun 130021, Jilin Province, China
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Kim SM, Lee SK. Chronic non-bacterial osteomyelitis in the jaw. J Korean Assoc Oral Maxillofac Surg 2019; 45:68-75. [PMID: 31106134 PMCID: PMC6502749 DOI: 10.5125/jkaoms.2019.45.2.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.
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Affiliation(s)
- Soung Min Kim
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, Sunyani, Ghana.,Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Suk Keun Lee
- Department of Oral Pathology, College of Dentistry and Institute of Oral Science, Gangneung-Wonju National University, Gangneung, Korea
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The Results of Endolymphatic Antibacterial Therapy in the Postoperative Period of Chronic Odontogenic Osteomyelitis of the Mandible. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2019. [DOI: 10.4028/www.scientific.net/jbbbe.41.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Surgery for severe chronic or atypical ongoing purulent-inflammatory diseases of the face and neck is performed alongside antibacterial therapy. We proposed the treatment of severe forms of the chronic stage of odontogenic osteomyelitis of the mandible using the method of direct intra-arterial lymphotropic therapy through the superficial temporal artery on the side of the lesion. The purpose of this study was to determine the concentration of antibiotic in the blood serum, flowing from the patient's mandible from the localization of the focus of pathology when the traditional (intravenous) and intra-arterial routes of administration are used during postoperative period of chronic odontogenic osteomyelitis of the mandible.
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Antao CJ, Dinkar AD, Khorate MM, Raut Dessai SS. Chronic Diffuse Sclerosing Osteomyelitis of the Mandible. Ann Maxillofac Surg 2019; 9:188-191. [PMID: 31293951 PMCID: PMC6585216 DOI: 10.4103/ams.ams_257_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic diffuse sclerosing osteomyelitis (CDSO) is a disease that presents a rather unusual clinicoradiographic picture creating diagnostic and therapeutic problems. Involvement of the temporomandibular joint is not frequently observed in CDSO. We report a unique case of a 37-year-old male with cyclic episodes of insidious swelling and progressive trismus for the past 4 years. Each episode was followed by spontaneous remission after 2 weeks. Radiographic examination detected unilateral coarse trabeculae with ground-glass appearance of the left hemimandible and resorption of ipsilateral condyle. Computed tomography demonstrated endosteal sclerosis, cortical thickening, and condylar resorption, while magnetic resonance imaging revealed altered marrow intensity with postcontrast enhancement of the surrounding musculature. Bone histopathology was consistent with the diagnosis of osteomyelitis. Palliative antibiotic therapy and regular follow-up were recommended. Of particular interest in the present case is ipsilateral condylar resorption not associated with any dermato-skeletal conditions, which is uncommon in CDSO of the mandible.
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Affiliation(s)
- Candice Jacinta Antao
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ajit Dattatray Dinkar
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Manisha Maruti Khorate
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Sapna S Raut Dessai
- Department of Oral Medicine and Radiology, Goa Dental College and Hospital, Bambolim, Goa, India
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Bocchialini G, Ferrari L, Rossini M, Bozzola A, Burlini D. Chronic nonbacterial osteomyelitis involving the mandible: A case report. Int J Surg Case Rep 2017; 37:149-153. [PMID: 28675846 PMCID: PMC5496487 DOI: 10.1016/j.ijscr.2017.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO), is a very rare condition of unknown aetiology. It is characterised by focal sterile inflammatory disease with prolonged, self-limiting and recurrent episodes. CASE PRESENTATION We report the discovery of this very rare disease following a mandibular abscess in a 10-year-old female. We initially focus on the difference between the preoperative orthopantomography and the maxillofacial computed tomography and magnetic resonance images obtained, and then on the improvement of strategies for correct diagnosis and treatment of this disease. DISCUSSION Bone pain and localised swelling can occur in a single bone or can spread to soft tissue and adjacent bone; areas commonly affected by CMRO include the metaphyseal plates of the long bones, as well as the spine, clavicle and, rarely, the maxillofacial area. The clinical presentation of CMRO includes pain, functional impairment, and swelling, similar to our case. CONCLUSIONS We report a very rare case of this unifocal mandibular disease in a child who presented for an abscess and was then diagnosed and treated for CNO.
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Affiliation(s)
| | - Luca Ferrari
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Manuela Rossini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
| | - Anna Bozzola
- Department of Molecular and Translational Medicine, Section of Pathology, University Spedali Civili Di Brescia, Spedali Civili di Brescia, Unità Operativa di anatomia patologica- Brescia, Italy
| | - Dante Burlini
- Maxillofacial Pediatric Surgery Unit, Ospedale dei Bambini-Asst., Spedali Civili, Brescia, Italy
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Fuchs A, Hartmann S, Ernestus K, Mutzbauer G, Linz C, Brands RC, Kübler AC, Müller-Richter UDA. Mandibular intraosseous pseudocarcinomatous hyperplasia: a case report. J Med Case Rep 2016; 10:268. [PMID: 27680099 PMCID: PMC5041521 DOI: 10.1186/s13256-016-1052-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
Background Mandibular pseudocarcinomatous hyperplasia is a rare and generally benign pathology. We report on one of these rare cases. Case presentation The case history of a 73-year-old white man stated that he had a carcinoma of the oropharynx, which was primarily treated with radiotherapy and chemotherapy 4 years prior. As a result of radiotherapy he developed an osteoradionecrosis of his mandible and a consecutive pathological fracture of his left mandibular angle. Subsequent osteosynthesis was performed with a reconstruction plate. When we first saw him, his reconstruction plate was partially exposed with intraoral and extraoral fistulation. The resected bone of his defect-bordering jaw showed the typical pathohistological findings of an intraosseous mandibular pseudocarcinomatous hyperplasia. After a first reconstruction attempt with an iliac crest graft failed, definitive reconstruction of his mandible with a microvascular anastomosed fibula graft was achieved. Conclusions Intraosseous pseudocarcinomatous hyperplasia of the mandible is a rare differential diagnosis in maxillofacial surgery. Besides other benign epithelial neoplasms, such as calcifying epithelial odontogenic tumor, squamous odontogenic tumor, or different forms of ameloblastoma, the far more frequent invasive squamous cell carcinoma needs to be excluded. A misinterpretation of pseudocarcinomatous hyperplasia as squamous cell carcinoma must be avoided because it can lead to a massive overtreatment.
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Affiliation(s)
- Andreas Fuchs
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Stefan Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Karen Ernestus
- Institute of Pathology and Comprehensive Cancer Center, University Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Grit Mutzbauer
- Institute of Pathology and Comprehensive Cancer Center, University Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Christian Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Roman C Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Alexander C Kübler
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Urs D A Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Syndromes with chronic non-bacterial osteomyelitis in the spine. Reumatologia 2016; 53:328-36. [PMID: 27407266 PMCID: PMC4847283 DOI: 10.5114/reum.2015.57639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/08/2016] [Indexed: 01/22/2023] Open
Abstract
Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background – chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome – that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice.
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Palla B, Burian E, Klecker JR, Fliefel R, Otto S. Systematic review of oral ulceration with bone sequestration. J Craniomaxillofac Surg 2015; 44:257-64. [PMID: 26782844 DOI: 10.1016/j.jcms.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 11/25/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This article represents the first systematic review entirely dedicated toward a disease called oral ulceration with bone sequestration (OUBS). We performed this review in order to further define and outline this disease. A secondary interest was to recognize the prevalence and importance of OUBS in relation to other oral disorders accompanied by ulceration and bone exposure. MATERIAL AND METHODS The systematic review was registered with PROSPERO (registration number CRD42015024294) and performed in cooperation with Harvard's Countway Library. Searches were built using MeSH terms and proximity operators previously mentioned in OUBS descriptions. Database searches were performed through EMBASE, Medline, and PubMed, followed by a handsearch of bibliographies for relevant articles. Articles were assessed against eligibility and inclusion criteria centering on bone exposure without known etiologic cause. We sought to gather information on patient age, sex, anatomical location, clinical presentation, and comorbidities. PRISMA guidelines were followed. RESULTS The searches identified 766 records total. Despite considerable inspection, we found only 8 articles qualifying for our review. In the 8 articles, there were a total of 24 patients fulfilling the criteria of OUBS. Although some abstracts mentioned idiopathic nature, most authors presented clinical cases with probable causes to ulceration and sequestration. The mean age of these patients was 43.21 ± 11.94 years. The male to female ratio was 3:1. The predominant area of occurrence was the mandible (n = 23, 95.8%). CONCLUSION The representation of OUBS in the literature remains scarce. More data must be generated and gathered on the concept of OUBS so as to determine the true incidence and importance of this disease. Despite rare occurrences of conditions characterizing OUBS, the recent discussion of this topic in the scientific community calls for more knowledge to be brought forth, with great benefit to patients suffering from ulcerative diseases and osteonecrosis.
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Affiliation(s)
| | - Egon Burian
- Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. Michael Ehrenfeld), Ludwig-Maximilians-Universität, Munich, Germany; Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Munich, Germany; Department of Oral & Maxillofacial Surgery, Alexandria University, Alexandria, Egypt
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery (Chair: Prof. Dr. Dr. Michael Ehrenfeld), Ludwig-Maximilians-Universität, Munich, Germany.
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Berglund C, Ekströmer K, Abtahi J. Primary Chronic Osteomyelitis of the Jaws in Children: An Update on Pathophysiology, Radiological Findings, Treatment Strategies, and Prospective Analysis of Two Cases. Case Rep Dent 2015; 2015:152717. [PMID: 26435856 PMCID: PMC4575997 DOI: 10.1155/2015/152717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/20/2015] [Indexed: 12/13/2022] Open
Abstract
Objective. Primary chronic osteomyelitis (PCO) of the jaws in children is associated with pain, trismus, and swelling. In children, temporomandibular joint involvement is rare and few studies have been published due to the relatively low incidence. This paper presents two cases of mandibular PCO in children with the involvement of the collum mandibulae. In addition, a review of the literature regarding demographic data, histological, radiological, and laboratory findings, and treatment strategies of PCO was also performed. Material and Methods. Prospective analyses of two PCO cases. A PubMed search was used and the articles were sorted according to their corresponding key area of focus. Results. Review of the literature revealed twenty-four cases of PCO with two cases of mandibular condyle involvement. The mean age was 18 years; the male to female ratio was 1 : 3. Most of the patients were treated with anti-inflammatory drugs in combination with decortication. Clinical recurrence was seen in 7 cases. Conclusion. A combination of anti-inflammatory drugs and surgical intervention appears to be the first choice of treatment. However, surgical removal of necrotic tissue adjacent to collum mandibulae has its limitations in children. Further investigations are of utmost importance in order to increase our knowledge and understanding of this disease.
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Affiliation(s)
- Caroline Berglund
- Department of Oral & Maxillofacial Surgery, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Karin Ekströmer
- Department of Radiology, Mälarsjukhuset Eskilstuna Hospital, Sweden
| | - Jahan Abtahi
- Department of Oral & Maxillofacial Surgery, Linköping University Hospital, 581 85 Linköping, Sweden
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Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy. Nucl Med Commun 2015; 35:797-807. [PMID: 24736329 DOI: 10.1097/mnm.0000000000000126] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of unknown etiology. It affects children and adolescents predominantly and occurs mostly in the female population. It is characterized by the insidious onset of pain and swelling, with a fluctuating clinical course of relapses and remissions. Typically, several bones are affected, either synchronously or metachronously, and bilateral involvement is common. CRMO most commonly affects the metaphysis of long bones, especially the tibia, femur, and clavicle. The spine, pelvis, ribs, sternum, and mandible may also be affected. Although lesions are mostly multiple, patients may present with a single symptomatic focus. Radiographic findings may be negative early in the course of the disease. Bone scintigraphy is useful in determining the presence of abnormality and the extent of disease. The imaging and clinical features of CRMO overlap with those of infectious osteomyelitis, bone malignancy, and inflammatory arthritis. Nonetheless, CRMO can be confidently diagnosed with the recognition of typical imaging patterns in the appropriate clinical setting. This article reviews imaging findings with special emphasis on bone scintigraphy and specific disease sites.
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Abstract
INTRODUCTION Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) is an acronym for various osteoarticular and dermatological manifestations that can appear in the same patient. It is a rare syndrome, but since its awareness has increased, there have been more and more such reports in the literature. AIMS The objectives of this review are to summarize the current state of knowledge on pediatric and adult-onset SAPHO syndrome, and to discuss treatment strategies that should be considered. RESULTS The SAPHO syndrome can affect patients of any age, and its etiology is still not known. The syndrome has its cognizable radiological characteristics that are most important in making the diagnosis. There are several diagnostic criteria as well, but they need further validation. No standard treatment protocols are available and current treatment options are not evidenced-based due to the rarity of the syndrome. Therapy is empirical and aimed at easing pain and modifying the inflammatory process. It includes nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line agents. Antibiotics, corticosteroids, disease-modifying anti-rheumatic drugs, biologicals targeting tumor necrosis factor alpha or interleukin-1, and bisphosphonates have all been used with variable success. Surgery is reserved to treat complications. Even though it is a disease with good long-term prognosis, its treatment remains a challenge and the results are known to be disappointing, especially with the skin component of the disease. CONCLUSION It is expected that these patients present at the time of diagnosis and the treatment should be as early, effective, and safe as possible in order to prevent osteoarticular progression and to limit the adverse events associated with pharmacological drugs.
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Affiliation(s)
- Iva Rukavina
- Department of Paediatrics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
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Patel R, Jacob R, Lee K, Booth TN. Parotid swelling and chronic recurrent multifocal osteomyelitis of mandible in children. Int J Pediatr Otorhinolaryngol 2015; 79:47-52. [PMID: 25468462 DOI: 10.1016/j.ijporl.2014.10.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chronic recurrent multifocal osteomyelitis (CRMO) is an aseptic inflammatory disorder of unknown etiology. CRMO involving the mandible is a diagnostic challenge due to a propensity for solitary involvement and lack of definitive radiologic or pathologic diagnosis. The purpose of this study is to report clinical and imaging findings in cohort of children with CRMO of the mandible. MATERIALS AND METHODS A retrospective search of the Picture Archiving Communication System (PACS) and accompanying reports was performed for studies with suspected osteomyelitis of the mandible. The electronic medical record, histopathology results, and imaging findings were also reviewed. Inclusion criteria included presentation and course as well as surgical biopsy consistent with CRMO. Four children satisfied our inclusion criteria. Mean age was 9.1 years (range 3.5-12). M:F ratio=1:3. RESULTS Patients presented with mild pain and swelling in the parotid region (n=4), mildly elevated sedimentation rate (n=3), and negative biopsy culture (n=4). A positive response to non-steroidal anti-inflammatory medication was noted in all patients. Imaging demonstrated a predominately sclerotic lesion in the posterior mandible associated with solid periosteal reaction in all patients. Cortical expansion (n=3) was commonly present. The clinical course was prolonged in the patients in whom a diagnosis of CRMO was not initially entertained. CONCLUSIONS Parotid mass or swelling is a common presentation of CRMO involving the mandible. The possibility of this diagnosis should be raised when typical clinical and imaging features are present. Whole body imaging may be helpful to evaluate for additional lesions. While biopsy is necessary with isolated mandibular involvement, repeated biopsies and prolonged antibiotic therapy should be avoided.
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Affiliation(s)
- Rajan Patel
- Department of Radiology, University of Texas Health Science Center, University of Texas Medical School, 6431 Fannin Street, Houston, TX 77030, United States.
| | - Roy Jacob
- Department of Radiology, University Medical Center, 602 Indiana Ave, Lubbock, TX 79415, United States.
| | - Kenneth Lee
- Department of Otolaryngology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, 1935 Medical District Drive, Dallas, TX 75235, United States.
| | - Timothy N Booth
- Department of Otolaryngology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, 1935 Medical District Drive, Dallas, TX 75235, United States; Department of Radiology, Children's Medical Center of Dallas, University of Texas Southwestern Medical School, 1935 Medical District Drive, Dallas, TX 75235, United States.
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26
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Lee L. Inflammatory Disease. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zaoui K, van de Weyer PS, Plinkert PK, Baumann I. [Differential diagnosis of headaches in otorhinolaryngology]. HNO 2012; 59:645-50. [PMID: 21509621 DOI: 10.1007/s00106-011-2268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Facial pain and headaches are heterogeneous, therefore, a differential diagnosis, interdisciplinary survey and mapping of the pain symptoms are essential for determination of treatment concepts. This requires an otorhinolaryngology (ENT) adapted zoning of the various pains in the head and neck in line with the classification of the International Headache Society (IHS). In this review, idiopathic, symptomatic and neuralgic facial pain and headaches will be differentiated and classified according to their location from the ENT medical point of view. This provides otolaryngologists with a simplified, targeted diagnosis and subsequent indication for therapy.
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Affiliation(s)
- K Zaoui
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland,
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Pham CT, Canale S, Boulet B, Brugières L, Lecarpentier T, Dromain C. A 14-year-old boy with mandibular tumor, spontaneous spinal fractures. Chronic recurrent multifocal osteomyelitis. Pediatr Ann 2011; 40:188-90. [PMID: 21485994 DOI: 10.3928/00904481-20110316-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chi-Tuan Pham
- Department of Diagnostic Radiology, Institut Gustave Roussy, Villejuif, France.
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