[A PhD completed. Treatment strategies for chronic diffuse sclerosing osteomyelitis of the mandible]

Chronic diffuse sclerosing osteomyelitis of the mandible is a relatively rare disease of unknown aetiology. Hyperactivity of the masticatory muscles has been suggested to be a contributing and/or causative factor for the syndrome, also known as chronic tendoperiostitis. A systematic review of the literature shows many treatment options with promising outcomes for conservative treatment and bisphosphonate treatment, and a low success rate for surgical treatment. Conservative treatment (occlusal splint therapy, physiotherapy and/or disease counselling) resulted in a reduction of complaints in 67% of patients; all patients showed improvement of their symptoms after bisphosphonate treatment. The only indication for surgery in chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible is remodelling surgery to treat complaints about facial asymmetry, caused by mandibular deformity. It is recommended to treat patients conservatively at first for at least 6-12 months. If symptoms do not improve sufficiently, supplementary bisphonate treatment can be initiated.