Primary Chronic Osteomyelitis Research Articles

TNF-alpha blockade in Primary Chronic Non-Bacterial Osteomyelitis of the Mandible.

Primary chronic Non-Bacterial Osteomyelitis of the jaw is a rare auto-inflammatory disease of unknown aetiology that bears pathophysiological resemblance to both the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome in adults and chronic recurrent multifocal osteomyelitis (CRMO) in children. Both SAPHO and CRMO respond to TNF-alpha blockade. Previously reported treatment regimens in CNOM including non-steroidal anti-inflammatory drugs, corticosteroids, antibiotics, anti-resorptive therapy, and surgery all bear disappointing results. TNF- α blockade is suggested as a treatment option by some experts but this is not backed by any clinical data.We sought to retrospectively and exhaustively report our experience of anti-TNF alpha therapy in refractory CNOM. Fifteen patients with refractory CNOM and high disease burden were referred to our centre. TNF- α blockade was attempted in 10 cases, given its efficacy in neighbouring diseases, its good tolerance profile and failure of previous treatment strategiesWe herein retrospectively report detailed outcomes for all patients having received anti-TNF alpha therapy for this indication in our centre. TNF-α-targeting therapy resulted in a rapid and sustained remission in a majority of patients with CNOM, without serious adverse events. Treatment was tapered and stopped without relapse in some patients despite a refractory course of several years. Male sex seems to be associated with a poorer outcome. Our results suggest that blocking TNF-α is efficient and safe in CNOM.

A literature review on various diagnostic modalities and treatment options for the treatment of the osteomyelitis of the jaw

Osteomyelitis of the jaw is found to be the most common disease affecting the maxillofacial region. Osteomyelitis is found to be true bacterial infection affecting the jaw bone. Different types of osteomyelitis which are distinguishable are acute osteomyelitis, primary chronic osteomyelitis and secondary chronic osteomyelitis of the jaw. The main characteristic features of the osteomyelitis of the jaw are, formation of the fistula, suppuration, and sequestration of the jaw bone. Different treatment modalities of the osteomyelitis of the jaw include surgery, debridement of the lesion superficially and curettage and in non surgical approach it includes usage of proper antibiotics, usage of topical agents, usage of hyperbaric oxygen, local anesthetic solution.

X-ray features and diagnostics of purulent-necrotic lesions of the jaws

X-ray data of 750 patients with odontogenic and non-odontogenic osteomyelitis of the jaws aged 18 to 65 years were studied. The results of orthopantomography, panoramic zonography of facial bones, telerentgenography of the skull, intraoral radiography, computed tomography of the maxillofacial region are analyzed.
 The radiological characteristics of odontogenic acute, subacute, chronic and primary chronic osteomyelitis, hematogenic and posttraumatic osteomyelitis, radiation, bisphosphonate and phosphorus necrosis of the jaws are presented, taking into account differential diagnosis.
 The radiological semiotics of osteomyelitis of the jaws is diverse, since the features of the manifestation of osteomyelitis depend on the etiology, stage of the course and form of the bone inflammatory process.
 Orthopantomography is a method of primary diagnosis of osteomyelitis of the jaws. The use of computed tomography contributes to the accurate identification of the structure of the affected area, the magnitude of the destruction of anatomical details of the jaws and the boundaries of the spread of the purulent-necrotic process.

Pharmacological Treatment of Primary Chronic Osteomyelitis: A Case Report

Pharmacological Treatment of Primary Chronic Osteomyelitis: A Case Report

66. Recurrent Facial Swelling: Primary Chronic Osteomyelitis Associated with an Unerupted Permanent Tooth in a Paediatric Patient

Sclerosing osteomyelitis affecting the jaws is a rare disorder in paediatric patients. As clinical findings can mimic dental infection clinicians must understand and consider this unusual pathology in their differential diagnoses. This potentially complex condition requires prompt diagnosis to permit definitive management. If identified early, a multi-disciplinary approach can be utilised to optimise patient care and outcome.

Chronic Osteomyelitis of the Jaw: Pivotal Role of Microbiological Investigation and Multidisciplinary Management—A Case Report

A 15-year-old girl with a history of recurrent painful orofacial swelling was diagnosed on the basis of clinical findings, histopathological examination and imaging modalities as having primary chronic osteomyelitis of the jaw. Initial microbiological samples were performed but were inconclusive. She received multiple empirical antibiotic therapies and NSAIDs for 3 years without complete remission. Only MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization–Time Of Flight) analysis after additional multiple microbiological bone samples with adequate techniques yielded the final diagnosis of bacterial chronic osteomyelitis of the jaw. Its management requires a multidisciplinary approach, involving oral and maxillofacial surgeons, infectiologists and microbiologists, to limit treatment failure. Antibiotic therapy without surgery for 6 months achieved the complete radiographic resolution of the CBCT (Cone Beam Computed Tomography) and the normalization of laboratory tests. After 2 years of follow-up, no relapse had been reported. Modern microbiological investigation and sampling techniques are critical for the accurate diagnosis and management of osteomyelitis of the jaw, especially in unusual and clinically misleading forms of this infection.

Primary Chronic Osteomyelitis of the Mandible: A 10 -Year Follow- Up

Primary Chronic Osteomyelitis of the Mandible: A 10 -Year Follow- Up

Osteomyelitis of the face: Clinicopathological study of a 15 year old database at the university hospital of yaoundé

ContextFacial osteomyelitis is an inflammatory process of the bones of the face. It is common in poor countries as a result of a weak health care system. The diagnosis and management of this pathology is complex in our context because of poor medical equipment. AimsThe objective of this study was to establish a nosological framework for facial osteomyelitis. Settingsand Design: This was a retrospective study of facial osteomyelitis collected in the Odontostomatology/Maxillo-Facial and Otolaryngology/Cervico-Facial Surgery Departments of the Yaoundé University Hospital over a period of 15 years. Methods and materialAll patients diagnosed with facial osteomyelitis by one of the physicians of the above departments mentioned services were included. An epidemiological record (sex, age, ethnic origin, risk factors, clinical, origin of the disease, imaging and biology) was collected for each patient. Osteomyelitis was classified according to the Zurich classification. Statistical analysis usedDescriptive statistics were performed and the Fisher test was used to indicate differences in radiographic characteristics between the types of facial osteomyelitis. A p-value of less than 0.05 was considered to indicate statistical significance. ResultsOf the ninety-nine facial osteomyelitis, eleven (12.3%) were acute and seventy-eight (87.6%) were chronic osteomyelitis, nine of which were primary and sixty-nine secondary. The presence of suppuration, fistula and or denudation were the prerogative of secondary chronic osteomyelitis. Heterogeneous spinal fibrosis and pseudodysplastic hyperplasia were pathognomonic of primary chronic osteomyelitis. ConclusionThese results suggest that the main differences between the types of osteomyelitis reside: in the duration of disease progression; whether or not suppuration/stripping and fistula are present; the presence or absence of mixed sclerosis, sequestration and fistula heterogeneous spinal cord fibrosis and pseudodysplastic hyperplasia.

The first experience of applying laser ablation in patients with benign tumors, tumor-like and inflammatory diseases of the skeleton

The researchers discuss the first experience of treating 9 pediatric patients with osteoid osteoma (3), primary chronic osteomyelitis (4) and aneurysmal cysts (2). Selected patients had complex treatment which included unloading of the diseased segment of the skeleton and laser ablation of the pathological focus. Laser ablation was done with medical laser «AZOR-ALM», emitting light at wavelength 1.55 μm. Registration certificate No. RZN 2015/2720 of Roszdravnadzor. Manufacturer – LLC «AZOR» (Moscow). Small tumors and inflammatory diseases of the skeleton were surgically treated with high-level laser light in the computed tomography room. Patients with lesions of lower extremities and pelvis previously had spinal anesthesia. If a pathologic focus was located in bones of upper extremities, regional brachial plexus blockage was preferable. In all cases, positive outcomes were seen. Follow-up lasted for 6 months.

Deceptively complex diagnosis of early onset primary chronic osteomyelitis: a case report

BackgroundPrimary chronic osteomyelitis is a rare occurrence in the pediatric mandible though it exclusively affects the mandible with no age preference. The absence of pus, fistula and sequestration are characteristic with insidious onset lacking an acute state. It is a chronic inflammatory disease of unknown etiology. It has two peaks of incidence: initial peak at adolescence and the second peak after the age of 50 years. Clinical and radiological presentation does not suffice the diagnosis of Primary chronic osteomyelitis necessitating biopsy followed by histopathological examination. Use of several terms in the literature to describe this disease entity has led to further confusion. The Zurich classification system satisfactorily describes the early onset Primary Chronic Osteomyelitis based on etiology and pathogenesis.Case presentationA case of Early Onset Primary Chronic Osteomyelitis in a 10 year old boy is reported comprehensively from clinical presentation to diagnosis and treatment. A meticulous hierarchical order of investigations leads the way to final diagnosis with the aid of existing literature. Extra-oral biopsy, decortication and antibiotic therapy proved to be an effective treatment with no recurrence at 1 year follow-up.ConclusionThe clinical and radiological features of Early Onset Primary Chronic Osteomyelitis are deceptively complex throwing an array of differential diagnosis including malignant tumors whilst histopathology reveals only chronic inflammation making this entity an enigma. This disease entity should be included in the differential diagnosis for a pediatric posterior mandibular swelling that occurs without an infectious nidus, pus discharge and fistula formation.

1369. The Spectrum of Chronic Osteomyelitis in Children

BackgroundWhile the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis in children.MethodsWe reviewed hospital admissions with an ICD10 code for chronic osteomyelitis from 2011-2018 at Texas Children’s Hospital. Cases were included if symptoms lasted >28 days on presentation. Patients diagnosed with chronic recurrent multifocal osteomyelitis were excluded. Cases were classified as those 1) associated with a contiguous focus (CoF), 2) penetrating or open trauma, 3) orthopedic hardware (OH), 4) post-acute chronic osteomyelitis (PACO, those occurring after >28 days of therapy for acute osteomyelitis) and 5) primary hematogenous chronic osteomyelitis (PHCO, those with 28 days of symptoms without other clear risk factors).Results114 cases met inclusion criteria. The median patient age is 11.8 years and 35.9% patients had underlying comorbidities. 83% of patients underwent a surgical procedure. Cases were diverse in terms of pathogenesis (Figure 1). A microbiologic etiology was identified in 72.8% of cases and was polymicrobial in 20.2% of cases; Staphylococcus aureus was the single most common etiology (Figure 2). CoF infection was more often associated with polymicrobial etiology with or without Pseudomonas (P< 0.001) and disease of the foot. PACO was caused by S. aureus in 95% of cases (p< 0.001, Figure 3). The overall median duration of total therapy was 210 days. 41% were discharged from hospital on OPAT with or without later transition to oral antibiotics. 26.3% of patients had persistent functional limitations at time of last follow-up of which 46% experienced repeat hospital admission/surgery. There was no association between duration of intravenous therapy and persistent functional limitations.Figure 1. Categories of Chronic Osteomyelitis Figure 2. Microbiology of Pediatric Chronic Osteomyelitis Figure 3. Clinical Features of Pediatric Chronic Osteomyelitis ConclusionChildren with chronic osteomyelitis are diverse both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve functional outcomes in chronic osteomyelitisDisclosures Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

Management of Garré\'s sclerosing osteomyelitis by endodontic therapy: A case report

Garre's osteomyelitis is a distinctive type of chronic osteomyelitis associated with gross thickening of the periosteum of the bones and peripheral reactive bone formation resulting from mild irritation or infections. The condition is seen in children or young adults and the mandible is more affected than the maxilla in most cases. The following is a case report of a 10 year old boy having Garre’s osteomylitis of the mandible due to the long standing infection and improper treatment of a carious tooth. Keywords: Primary chronic osteomyelitis (PCO), Acute osteomyelitis (AO), Chronic osteomyelitis with peripheral periostites COPP.

Sickle cell osteomyelitis: A novel approach and review of the literature

AbstractAimSickle cell disease is a well‐recognized risk factor for the development of osteomyelitis. Its occurrence in the mandible is both complex and challenging. Antibiotics and surgery remain the main treatment modalities, but both have varying success in refractory osteomyelitis. With increasing individual clinical cases highlighting the successful management of both primary and secondary chronic osteomyelitis with bisphosphonate therapy, it was considered a viable last line trial medication prior to aggressive surgery in refractory sickle cell osteomyelitis.Materials and methodsTwo cases are retrospectively reported for the use of oral bisphosphonates.ResultsBoth cases showed positive outcomes both clinically and radiographically in response to oral bisphosphonates with no recurrence of acute episodes even on the background of recurring sickle crises.ConclusionThe current cases are the first in the literature to report successful management of sickle cell osteomyelitis with oral bisphosphonates and explores the literature on previous reports of the condition.

Secondary chronic osteomyelitis of the mandible: A resistant disease successfully treated with bisphosphonate therapy

AbstractManagement of secondary chronic osteomyelitis (SCO) of the mandible is complex and challenging condition. Antibiotics are often first line treatment but have difficulty penetrating the infected bone and surgical intervention can be extensive, disfiguring and may not provide cure. With increasing reports of successful management of primary chronic osteomyelitis with bisphosphonate therapy, it was considered a viable last line trial medication in a refractory SCO patient for whom surgery was not appropriate. The current case is the first in the literature to report successful management of SCO with oral bisphosphonates.

A boy with recurrent swelling of the jaw.

We present a 10-year old boy with recurrent swelling of the right mandibular region. Based on the diagnosis of chronic recurrent parotitis, he received only supportive treatment. Because of frequent relapses, the diagnosis was reconsidered. Magnetic resonance imaging, scintigraphy and biopsy were compatible with chronic osteomyelitis. This lead to a diagnosis of mandibular primary chronic osteomyelitis, an uncommon non-suppurative inflammatory disease of unknown origin. After decortication of the mandible, the patient recovered well. Because there were no further complaints, the follow-up was ended 18 months after the operation.

Clinical and immunological approach to differential diagnostics and surgical treatment of primary chronic osteomyelitis of the lower jaw

Clinical and immunological approach to differential diagnostics and surgical treatment of primary chronic osteomyelitis of the lower jaw

Osteomyelitis of the jaws: A retrospective series of 40 patients

The caseload of jaw osteomyelitis seem to have decreased considerably over the last fifty years thanks to the progress of oral hygiene, the appearance and the use of antibiotics, and early screening. 'Limited osteitis' remains frequent in general practice (alveolitis after dental extraction), but osteomyelitis is much rarer as evidenced by the lack of current literature and the low number of reported patients in the published series. The aim of this study was to analyze retrospectively all the cases of maxillo-mandibular osteomyelitis treated in a large academic department of Stomatology and Maxillofacial Surgery over a period of 6 years and to compare the results to data from the literature. All patients diagnosed with maxillo-mandibular osteomyelitis by one of the staff surgeons between January 2009 and December 2015 was included. An epidemiological record (sex, age, ethnic background, risk factors, clinical, origin of disease, imaging and biology, treatments and progression) were collected for each patient. Osteomyelitis cases were classified according to the Zurich Classification System. Results were compared to data from the literature. Forty patients were retained. Three presented acute osteomyelitis, 26 secondary chronic osteomyelitis and 11 a primary chronic osteomyelitis. Osteomyelitis affected predominantly the mandible (87%). Dental origin was found in 90% of cases. Nine patients (22.5%) recovered and 29 (90%) were clinically improved. Ten of the 11 patients with primary chronic osteomyelitis were improved. This cohort study is one of the largest series currently available and presents results comparable to those of the literature of the last 25years.

Primary chronic osteomyelitis of the jaw in children: case series and literature review

Primary chronic osteomyelitis of the jaw in children: case series and literature review

Primary Chronic Osteomyelitis of the Jaws in Children: An Update on Pathophysiology, Radiological Findings, Treatment Strategies, and Prospective Analysis of Two Cases

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.

Analysis of the factors affecting the formation of the microbiome associated with chronic osteomyelitis of the jaw

Chronic osteomyelitis of the jaw (COMJ) is one of the most intractable diseases among head and neck infections. Antimicrobial agents are routinely administered for COMJ without sufficient bacterial information, resulting in frequent treatment failures. To improve our knowledge of the bacterial aetiology of COMJ and to assist in the development of effective treatments, we performed a comprehensive analysis of the microbiome. Sixteen patients with four clinical types of COMJ (four with suppurative osteomyelitis, three with osteoradionecrosis of the jaw, four with primary chronic osteomyelitis, and five with bisphosphonate-related osteonecrosis of the jaw) were enrolled in this study. Bone samples were subjected to bacterial community comparisons by 16S rRNA gene pyrosequencing. As a result, we clarified that COMJ was caused by a far greater range of bacterial species (12 phyla and 163 genera) than previously reported. Moreover, the bacterial structures in COMJ changed dramatically with disease stage and the condition of the affected bone. Multiple correlation analyses revealed that sequestration and bone exposure could affect the community structure. On the basis of these factors, we reclassified COMJ into three clinical stages: I, inflamed or sclerotic bone without exposure; II, sequestrum without exposure; and III, exposed sequestrum. In stage II, the bacterial diversity was significantly lower, and the anaerobe genera Fusobacterium, Tannerella (formerly Bacteroides) and Porphyromonas were more abundant, than observed during other stages. Because these bacteria habitually reside in any clinical stage, they were considered to constitute the core microbiome of COMJ. Targeting these bacteria should lead to the development of effective preventive measures and cures.