Management of osteomyelitis of the mandible - a 15-year case series

Osteomyelitis of the mandible is uncommon in the current age of antimicrobials. When it occurs, the effects can be devastating, both functionally and aesthetically. The low volume of cases means clinicians are unlikely to gain significant experience in managing this condition. In this 15-year retrospective case series, all cases of osteomyelitis of the mandible treated at our tertiary referral centre were identified. Data on patient demographics, risk factors, treatment regimens, and outcomes were collected. The Zurich classification system was used to group cases into Acute (AO), Secondary Chronic (SCO) and Primary Chronic (PCO) osteomyelitis. A total of 60 patients were included for analysis. Mean age was 43 years (8-77), and males and females were equally affected. The commonest aetiology was odontogenic (76.7%), followed by trauma. The commonest organisms were mouth commensals, with a significant association of less virulent organisms in SCO compared with AO (p = 0.018). There was a significant difference in the prevalence of systemic factors between AO and SCO patients (p < 0.001). Six weeks of antibiotics was sufficient to treat most AO cases (n = 13). SCO cases (n = 43) treated with surgical debridement combined with antibiotics had better initial outcomes. To our knowledge, this represents one of the largest series of mandibular osteomyelitis to date. Osteomyelitis of the mandible is an uncommon and challenging condition, requiring a multidisciplinary approach. There are important differences between SCO and AO that surgeons must consider, including host factors, organisms and treatment strategies.