Chronic, nonbacterial, multicentric osteomyelitis in the mandible

Abstract

Chronic nonbacterial osteomyelitis is a sterile inflammatory osteitis that most commonly develops in the long bones, but it can occur in any bone. Mandibular lesions are found in 1.5-3% of disease foci in patients and it is poorly characterized in the maxillofacial surgery literature due to the use of inconsistent terminology. The purpose of this study was to present the clinical experience of chronic nonbacterial multicentric osteomyelitis and a collection of research and information of the disease. This is a retrospective study of 2 cases with mandibular lesions radiographically consistent with osteomyelitis without infection. Medical records were reviewed for history, clinical features, imaging and pathology. The study included 2 patients (2 females, age of 17 and 43 years). Both reported mandibular pain and swelling, radiographic finding of multifocal intraosseal inflammatory lesions. Computed tomography scans typically showed expansion of the affected mandible with sclerosis of the medullary space, small foci of poorly defined lytic destruction with lamellated periosteal reaction. Both patients showed a long ineffective antibiotic therapy and recurrent flare-ups of inflammation. After the proper course of treatment (nonsteroid and steroid therapy), a long painless period was reached. Chronic multicentric nonbacterial osteomyelitis has been reported to be uncommon in the mandible, but it may be more common with correct diagnosis, typified by recurrent pain and swelling with characteristic pathologic and radiologic features. The current treatment modalities include nonsteroidal anti-inflammatory drugs or steroids. Orv Hetil. 2018; 159(43): 1761-1766.