Clinical observations on chronic osteomyelitis of the mandible

Abstract

Chronic mandibular osteomyelitis (CMO) is an inflammatory disease that is resistant to treatment. This paper describes 16 cases of CMO that were treated in our hospital between 1986 and 1992. The discussion includes various methods of treatment. An insufficient inferior alveolar artery (IAA) blood supply as determined by angiography also played a role in CMO. In the above cases, CMO was caused by several different dental diseases.1. Ten cases were diagnosed histopathologically as supprative osteomyelitis; the remaining 6 cases were determined to be sclerosing osteomyelitis. Female patients in their fourth decade accounted for the biggest subgroup. The most frequent tooth involved was the mandibular molar.2. Patients with supprative osteomyelitis showed characteristic symptoms: a) short duration of disease, b) local infection, c) pus discharge, and d) fistula formation. Sequestrectomy was most frequently used as a corrective procedure. Decortication combined with sequestrectomy was used in all cases with sclerotic changes of bone cortex.3. Sclerosing osteomyelitis was clinically characterized by a long duration of disease, diffuse sclerotic changes on X-ray, and associated trismus. Among 4 cases of sclerosing osteomyelitis that underwent angiography of the IAA, 3 cases showed deformities. Therefore, angiography seemed to be a useful procedure to forecast the prognosis because it evaluates the blood supply into the mandible. Consequently, a decreased blood supply might indicate a poor response to antibiotic therapy. In cases without IAA deformity, decorticotomy alone was sufficient for treatment. On the other hand, in the cases of IAA deformity, treatment included a combination of intra-arterial antibiotic infusion and decorticotomy or saucerization.The above procedures resulted in cure in all but 1 case of CMO.