Primary Chronic Osteomyelitis of the Jaw - A Case Report and a Review of the Literature

Abstract

Primary chronic osteomyelitis (PCO) of the jaw, also known as diffuse sclerosing osteomyelitis (DSO) of the jaw, chronic recurrent multifocal osteomyelitis or the SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, is a nonsuppurative inflammatory process associated with recurrent swelling, trismus and pain. Microorganisms from bone samples have been difficult to cultivate, and there is often a negative response to antibiotic treatment in PCO. PURPOSE: This case report presents a 25-year-old woman suffering from PCO since the age of nine and she has been further diagnosed with the SAPHO-syndrome in adult age. A review of diagnostic investigations and the management of PCO will be included. STUDY DESIGN: A case of primary chronic osteomyelitis of the lower jaw is presented with a detailed review of diagnostics and the management of PCO, using this case to illustrate key points of management. Methods of Data Analysis: Radiological examinations such as MRI, CT scanning and scintigraphic imaging have been useful diagnostic investigations as well as histological and bacteriological sampling. Different treatment-protocols with antibiotics, NSAIDs, systemic and topical steroids, bisphosphonates, TNF-alpha blockers, Methotrexate, hyperbaric oxygen therapy and surgical intervention have been tried out in this case and will be discussed. Microorganisms from bone samples have been proven difficult to investigate due to contamination with oral bacterial flora when intraoral harvesting is performed. Therefore, different bone sample techniques like retro-/submandibular harvesting as tried in this case, may be used. Some of the potential causative microorganismes are difficult or impossible to culture. Improved investigation techniques like the PCR-technique when performing microbiological analysis may be a useful diagnostic aid. In this case TNF-alpha blockers appear to be the treatment of choice.