Infection, neoplasia and bone dysplasias cause alteration in bone architecture. Florid cemento-osseous dysplasia (FCOD) and chronic diffuse osteomyelitis (CDO) are two independent disease processes that may have overlapping clinical and radiographic characteristics. Differential diagnosis can be crucial, as the course of each process and its clinical management varies.
Case Description
A patient reported to the oral and maxillofacial radiology clinic at the University of Medicine and Dentistry of New Jersey's New Jersey Dental School with a complaint of chronic pain in the mandible. One of the authors (S.R.S.) obtained a panoramic radiograph. Later, the patient underwent computerized tomographic examination and biopsy. On the basis of the clinical, radiographic and histopathologic examinations, the authors made diagnoses of CDO and FCOD. The bilateral presentation of CDO along with the simultaneous presence of FCOD and these conditions' vivid radiographic appearances make this case highly unusual.
Clinical Implications
Multiple, simultaneous processes can yield an atypical radiographic appearance seen on routine radiographic examinations. Characteristics unique to each process are used to make the differential diagnoses. FCOD can make the mandible more susceptible to osteomyelitis.
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CASE REPORT
A 61-year-old African woman reported to the oral and maxillofacial radiology clinic at the University of Medicine and Dentistry of New Jersey's (UMDNJ's) New Jersey Dental School, Newark, with a chief complaint of chronic pain in the mandible that had lasted approximately five years. She had immigrated to the United States less than a year before and arrived at the dental school with her daughter, who acted as her interpreter. Two of us (S.R.S. and M.M.) performed a clinical
DISCUSSION
Fibro-osseous lesions are a group of disorders of bone in which normal bone is replaced with fibrous connective tissue containing abnormal bone or cementum. Included in this group are FCOD, fibrous dysplasia and periapical cemental dysplasia (PCD).6 The initial radiographic appearance of this group of lesions is radiolucent. Over time, the lesions progress to a mixed radiolucent-radiopaque stage before progressing to a completely radiopaque stage. The normal trabecular pattern of bone is not
CONCLUSION
Multiple, simultaneous pathological processes can yield an atypical radiographic appearance in routine dental radiographs such as full-mouth series or panoramic radiographs. The effects of the overlying inflammatory process on the primary fibro-osseous lesions can alter its radiographic features. In our patient, the primary, underlying FCOD had undergone changes that were radiographically discernible owing to the initial infection of the FCOD and the subsequent CDO. We noted characteristics
2023, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
All three clinical types are associated with vital teeth and can be diagnosed based on clinical and radiographic features alone. No biopsy or treatment is recommended for these lesions, as surgical procedures can lead to complications such as secondary infection and osteomyelitis [10]. Histologically, COD has overlapping features with EOD, therefore, differentiation requires clinical correlation and cannot be based on histological features alone.
Expansive osseous dysplasia (EOD) was first described in 2011 and is characterized by gross expansion in single or multiple areas of the jawbones while showing radiographic and histological features of cemento-osseous dysplasia (COD). We present a case of EOD to increase clinical awareness of this rare and newly described entity. A 30-year-old black female presented with asymptomatic bony expansion of the right mandible. Imaging studies revealed mixed radiopaque/radiolucent lesions throughout mandible and right maxilla, consistent with florid cemento-osseous dysplasia. Biopsies showed features consistent with EOD. The patient underwent a right segmental mandibulectomy with inferior alveolar nerve lateralization and transposition, followed by a reconstruction with a left fibular free flap. No additional bony expansion has been noted at 9 months post-surgery. EOD is rare and diagnosis requires clinical correlation. EOD appears mostly arising in florid COD, therefore, continued clinical follow-up for all COD cases is emphasized.
2023, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Mandibular osteomyelitis remains an incompletely understood entity, and treatment of its various presentations remains diverse. The purpose of this study was to review the necessity of antibiotic therapy after surgical treatment of mandibular osteomyelitis.
A systematic review of published articles on surgical management of mandibular osteomyelitis with or without postoperative antibiotic therapy was performed to answer the question, “Does the use of postoperative antibiotics compared with surgery alone alter the success rate in treating mandibular osteomyelitis?” The most recent evidence was sought by searching PubMed, Embase, and Scopus databases. Article appraisal was performed by 2 reviewers.
Forty-five articles were found that met the inclusion criteria, with all studies being retrospective cohort or case series designs. Only 13 articles used Zurich classification designations of acute osteomyelitis, secondary chronic osteomyelitis, or primary chronic osteomyelitis, and the general heterogeneity of these articles made comparison difficult. No study made an intentional statistical assessment of various antibiotic protocols.
Limited evidence suggested that resection may have better success rates than other forms of surgical intervention, regardless of antibiotic therapy. This systematic review questions the perceived necessity of intermediate- or long-term antibiotic therapy in the management of mandibular osteomyelitis after surgical resection.
This case report describes a 36-year-old Asian female with severe skeletal Class II bimaxillary protrusion and periapical cemento-osseous dysplasia (PCOD) who underwent orthodontic treatment with extraction of four premolars. The pretreatment radiograph showed a mixed radiolucent and radiopaque lesion around the root apices of the mandibular incisors, and no root resorption was found. The pulp vitality of these involved incisors was still normal. These findings together suggested an initial diagnosis of PCOD. After careful consideration, four premolars were extracted, and four miniscrews were used to retract the anterior teeth. The orthodontic treatment took 35 months, and oral hygiene was repeatedly emphasized. The patient's profile improved obviously, and these involved incisors still presented normal vitality, but several bone spicules appeared in the labial alveolar bone of the mandibular anterior teeth. PCOD may affect alveolar bone remodeling and the movement of teeth in the PCOD area. Cone-beam computed tomography showed a mixed radiolucent and radiopaque lesion around the root apices of these incisors, indicating that PCOD was still at the osteogenic stage. The 2.5-year follow-up radiograph showed that the lesion had no further change, the pulp vitality was still normal, and the orthodontic results were stable.
2021, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
Nevertheless, 2 of the significant features, discontinuity of the cortical plates and sequestrum formation, are expected to be most clearly demonstrated on volumetric imaging. This suggests the importance of conducting 3-dimensional imaging for patients in whom secondary infection of OD is suspected.1,26,27 The recent paper by Kato et al.24 based its description of infected OD on cases with planar radiographs (periapical and panoramic) only, whereas this study uniquely used advanced imaging to identify radiographic features indicative of infected OD lesions.
The aims of this study were to identify radiographic features that distinguish osseous dysplasia–related osteomyelitis (OD-related OM) from OD without OM and to detect possible causes of OD-related OM.
Seventeen OD cases with and without OM were examined on planar and volumetric (cone beam computed tomography or multidetector computed tomography) imaging. Cases were divided into 3 groups based on clinical data: symptomatic OM, incidental (asymptomatic) OM, and control (OD without OM). Images were reviewed by 3 precalibrated observers, blinded to clinical information, for OD characteristics (location and extent); radiographic features of OD-related OM; and possible causes. Radiographic features of OD-related OM chosen by at least 2 observers were statistically analyzed within and between groups.
Discontinuity of the cortical plates, widening of the radiolucent rim, decreased attenuation of the radiolucent rim, and sequestrum formation were significantly more common in symptomatic and incidental OM groups than in the control group (P ≤ .05). Two causes, atrophy of the edentulous ridge and presence of a periapical lesion, were also correlated with OD-related OM (P ≤ .05, P ≤ .01, respectively).
Radiographic features can distinguish OD-related OM from OD. Familiarity with these radiographic features and possible causes may help improve the identification of secondarily infected OD.
This review aims to overview key histopathological features and provide diagnostic clues for a selection of the fibro-osseous lesions of the jaws and facial bones. These form a diverse group of conditions with differing aetiologies but similar histological appearances. Some may be part of more generalized systemic disease. It will become apparent that for this group of conditions, diagnosis cannot be made by examination of biopsy material by a pathologist in isolation, and both clinical and radiological correlation is needed. However, there are some subtle histopathological features that can allow one diagnosis to be favoured over all others, and these will be outlined. Identification of these features in material sent for histopathological analysis should assist the multidisciplinary team in making a definitive diagnosis.
2016, Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
La dysplasie osseuse floride est une pathologie fibro-osseuse rare et bénigne au cours de laquelle l’os est remplacé par du tissu fibreux et de l’os métaplasique. Elle peut rester longtemps asymptomatique et elle est le plus souvent découverte fortuitement lors d’un examen radiologique de routine. Parfois, les patients consultent à la suite d’une complication infectieuse.
Une patiente de 62 ans édentée, s’est présentée en consultation pour une tuméfaction mandibulaire douloureuse empêchant l’insertion de sa prothèse amovible. L’examen clinique montrait une tuméfaction mentonnière avec une déformation antérieure des tables osseuses mandibulaires d’environ quatre centimètres de diamètre. S’y associaient une fistulisation intra-orale et une suppuration. L’examen radiologique montrait une lésion osseuse mixte soufflant les corticales vestibulaire et linguale et un séquestre osseux. L’examen biologique était normal et il n’y avait pas d’autres anomalies du squelette. La confrontation des examens clinique, radiologique et anatomopathologique a permis de poser le diagnostic de dysplasie osseuse floride. L’exérèse du séquestre osseux associée à une ostéoplastie de remodelage mandibulaire a été réalisée sous anesthésie générale. La prothèse amovible a été rebasée afin de guider la cicatrisation.
La prise en charge chirurgicale d’une dysplasie osseuse floride n’est légitime qu’en présence de complications ne répondant pas à un traitement médical. Dans tous les autres cas, l’abstention thérapeutique et la surveillance prolongée sont primordiales.
Florid osseous dysplasia is a rare and benign fibro-osseous pathology, in which bone is replaced by fibrous tissue and metaplastic bone. It can remain asymptomatic for a long time and is most often discovered incidentally during a radiological examination. Sometimes, patients are seen because of an infectious complication.
An edentulous 62 years-old woman was referred for a painful mandibular swelling preventing insertion of her removable denture. Clinical examination showed a chin swelling, a deformation of mandibular bone tables of approximately four centimeters in diameter, an intra-oral fistula and a suppuration. Radiological examination showed a mixed bone lesion blowing up the buccal and lingual cortical plates and a bone sequestrum. Blood test was normal and there were no other skeletal abnormalities. The diagnosis of florid osseous bone dysplasia was made thanks to the confrontation of the clinical, radiological and histological examinations. Excision of the bone sequestrum associated to remodeling osteoplasty was performed under general anesthesia. The removable denture was rebased to drivehealing.
Surgical management of osseous bone dysplasia is legitimate only in the presence of complications not responding to medical treatment. In all other cases, therapeutic abstention and long term supervision are essential.
The material in this article originally was presented as an abstract at the 54th annual session of the American Academy of Oral and Maxillo-facial Radiology, Dec. 4, 2003, Chicago.
Dr. Singer is an associate professor, Department of Diagnostic Sciences, Room D 860, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen St., Newark, N.J. 07101
Dr. Mupparapu is an associate professor, Department of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark.
Joseph Rinaggio is an assistant professor, Department of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark.
