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Chronic recurrent osteomyelitis: A surgeon's enigma.

Adarsh Kudva1, Abhay T Kamath1, Vasantha Dhara1

  • 1Department of Oral & Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Karnataka, India.

Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology
|December 20, 2018
PubMed
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Recurrent osteomyelitis of the mandible presents diagnostic and treatment challenges. Aggressive medical management, including long-term antibiotics and anti-inflammatories, alongside surgical intervention when needed, leads to symptom resolution.

Area of Science:

  • Maxillofacial Surgery
  • Infectious Diseases
  • Oral and Maxillofacial Surgery

Background:

  • Chronic recurrent osteomyelitis of the mandible poses significant diagnostic and treatment challenges for maxillofacial surgeons.
  • Existing classifications and treatments for mandibular osteomyelitis in adults and children have been developed over time.
  • This study examines two cases of recurrent osteomyelitis in adult and pediatric patients, focusing on diagnostic and therapeutic difficulties.

Purpose of the Study:

  • To highlight the diagnostic and treatment challenges associated with chronic recurrent osteomyelitis of the mandible.
  • To present two case studies of recurrent mandibular osteomyelitis in adult and pediatric patients.
  • To correlate clinical findings and treatment plans with existing evidence-based literature.

Main Methods:

Keywords:
chronic recurrent multifocal osteomyelitiscomputed tomographynon-steroidal anti-inflammatory drugssclerosing osteomyelitissteroids

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  • Comprehensive patient workup including clinical examination, radiographic imaging, and blood investigations.
  • Administration of antibiotics and anti-inflammatory medications, with consideration for surgical debridement or adjuvant therapies.
  • Correlation of case findings and treatment strategies with evidence-based medical literature.

Main Results:

  • Complete resolution of osteomyelitis symptoms and radiographic evidence was achieved in both cases.
  • Long-term administration of steroids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics demonstrated improved outcomes during recurrence periods.
  • Successful management was achieved through a combination of medical and surgical interventions.

Conclusions:

  • An evidence-based protocol for osteomyelitis emphasizes efficient literature review and short inpatient stays.
  • Thorough clinical and radiographic evaluation, coupled with aggressive medical management and timely surgical intervention, promotes extended symptom-free periods.
  • Understanding the disease's characteristics, recurrence patterns, and therapeutic responses is crucial for effective patient management.