R.H. Groot

Diffuse sclerosing osteomyelitis of the mandible: Clinical radiographic and histologic findings in twenty-seven patients

Diffuse sclerosing osteomyelitis of the mandible is a disease of obscure origin that may give rise to diagnostic problems. In the literature most authors suggest an infectious etiology. However, the results of treatment are generally poor. Clinical and radiographic findings in this study of 27 patients suggested an infectious origin of the disease. However, bacteriologic findings in 11 of these cases did not support this suggestion. The histologic findings showed a reactive hyperplasia of bone. The results of treatment, based on the assumption of an infectious etiology, were poor. It was concluded that the findings in this group of patients did not support an infectious etiology of the disease.

Intra-operative complications in sagittal and vertical ramus osteotomies

In orthognatic surgery of the mandibular ramus, intra-operative complications as a lesion of the inferior alveolar nerve, fractures of the osteotomised segments, incomplete sectioning, malpositioning of segments and haemorrhage may occur. In this report, intra-operative complications in 124 sagittal split osteotomies and 34 vertical ramus osteotomies, carried out in 80 patients, are described. The incidence of intra-operative complications in the sagittal split osteotomies was 25.8%. The complication occurring most frequently was incomplete sectioning (11.2%). This may be avoided by using the modified sagittal split technique. The incidence of complications in the vertical ramus osteotomies was 11.8%.

Diffuse sclerosing osteomyelitis and florid osseous dysplasia

The literature on diffuse sclerosing osteomyelitis of the mandible has included at least two groups of lesions: (1) those from which bacterial infectious agents are rarely isolated (chronic-tendoperiostitis); and (2) those from which bacteria are readily isolated (true diffuse sclerosing osteomyelitis). The latter should be distinguished from secondarily infected florid osseous dysplasia. In this article the features of 16 patients with sclerotic jawbone lesions associated with symptoms of infection are analyzed. Eleven patients showed a large area of sclerosis of the mandible that was not restricted to the alveolar process and was surrounding an infectious focus. The histologic pattern revealed a deposition of reactive bone. These lesions are considered to represent true diffuse sclerosing osteomyelitis. The remaining five patients showed sclerotic lesions restricted to the alveolar process in one or more quadrants of the jaws. Apart from inflammation and reactive changes, histologic pattern revealed a fibroblastic stroma with bone and cementum-like structures that are formed by metaplasia. These lesions are considered to represent secondarily infected florid osseous dysplasia.

Diffuse sclerosing osteomyelitis of the mandible: a new concept of its etiology.

Diffuse sclerosing osteomyelitis of the mandible is a disease of unknown etiology. The clinical and radiographic findings suggest an infectious origin, but bacteriologic and histologic findings do not support this concept. Analysis of clinical symptoms, localization of the condition, and posttreatment findings in a group of 27 patients suggest a chronic tendoperiostitis due to muscular overuse as an etiologic factor in diffuse sclerosing osteomyelitis of the mandible. This hypothesis was supported by the initial results of muscle relaxation treatment in 13 of these patients.

Neurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: A multi-centre prospective study

Bilateral sagittal split osteotomy (BSSO) is an effective and commonly used treatment to correct mandibular hypo- and hyperplasia. Hypoesthesia of the inferior alveolar nerve (IAN) is a common complication of this surgical procedure. This prospective multi-centre study aimed to determine the incidence of neurosensory disturbances of the IAN after BSSO procedures performed without the use of chisels. Our study group comprised 158 patients, with a follow-up period of 1 year, who underwent BSSO (with or without Le Fort I) that incorporated the use of sagittal split separators and splitters but no chisels. The percentage of BSSO split procedures that resulted in IAN damage was 5.1%. The percentage of patients (without genioplasty) who experienced IAN damage was 8.9%. The concomitant genioplasty in combination with BSSO was significantly associated with hypoesthesia. Peri-operative removal of the wisdom tooth or a Le Fort I procedure did not influence post-operative hypoesthesia. We believe that the use of splitting forceps and elevators without chisels leads to a lower incidence of persistent post-operative hypoesthesia 1 year after BSSO of the mandible, without increasing the risk of a bad split.

Treatment of chronic suppurative osteomyelitis of the mandible

Chronic suppurative osteomyelitis of the mandible is often considered difficult to treat and may lead to refractory osteomyelitis. Sixteen patients with chronic suppurative osteomyelitis of the mandible were treated with a relatively simple protocol, consisting of sequestrectomy or decortication and i.v. antimicrobial therapy for one week, followed by oral penicillin for three weeks. Only one case showed recurrence of symptoms, which was treated successfully in a second session. It is concluded that combined surgical and antimicrobial therapy should be sufficient to cure most cases of chronic suppurative osteomyelitis of the mandible.

Oral manifestations of non-Hodgkin's lymphoma in HIV-infected patients.

The incidence of non-Hodgkins lymphomas (NHL) in patients infected with human immunodeficiency virus (HIV) is relatively high. However, there have been few reports on the clinical and histopathological features of oral manifestations of NHL in these patients. The lesions reported so far were all tumorous swellings with or without ulceration, as in non-HIV-infected patients. In this report 3 cases are presented of HIV-infected patients with solitary, primary oral NHL. These lesions showed a striking resemblance to acute, necrotizing gingivitis, a common finding in these patients, thus making the diagnosis more difficult.

Diffuse sclerosing osteomyelitis (chronic tendoperiostitis) of the mandible : An 11-year follow-up report

Diffuse sclerosing osteomyelitis of the mandible is a disease that is characterized by a protracted course of recurrent pain, swelling of the cheek, and trismus. The cause of the lesion has been obscure for a long period of time. Recent research, however, pointed out that this disease is likely to be caused by overuse of the jaw musculature (chronic tendoperiostitis) and can be treated accordingly. The protracted course of the disease and the difficulty of treatment with an eventual positive outcome are illustrated by a case report of a 65-year-old man with an 11-year history of diffuse sclerosing osteomyelitis (chronic tendoperiostitis) of the mandible.

Changes in masseter inhibitory reflex responses in patients with diffuse sclerosing osteomyelitis of the mandible

Masticatory inhibitory mechanisms were studied in 10 patients treated for diffuse sclerosing osteomyelitis of the mandible. Their masseter inhibitory reflex responses were provoked electrically by mental nerve stimulation during maximal clenching of the teeth. The masseter inhibitory reflex was normal in two patients and significantly abnormal in eight patients. The two patients with a normal masseter inhibitory reflex were free of complaints, whereas, of the eight patients with an abnormal masseter inhibitory reflex, two were free of complaints and six had moderate to severe symptoms. In three patients, spasms and involuntary bursts of electromyographic activity were found. The abnormal masseter inhibitory reflex consisted of a loss of early and late components in four patients or a loss of the late component with a normal early one in four patients. These findings seem to support the hypothesis that diffuse sclerosing osteomyelitis of the mandible is a chronic tendoperiostitis caused by muscle overuse. It is suggested that this overuse is caused by central hyperexcitability of trigeminal motoneurons.

Twenty-year follow-up of reconstruction with allogeneic hemimandible and autogenous particulate bone and cancellous marrow

This report shows a long-term follow-up of a mandibular reconstruction with a composite graft, consisting of an allogeneic bone crib packed with autogenous particulate bone and cancellous marrow (PBCM). In this patient, segmental mandibulectomy including exarticulation of the temporomandibular joint (TMJ) had been necessary, due to recurrent odontogenic myxoma including the TMJ. Reconstruction was performed with an allogeneic freeze-dried hemimandible with TMJ, packed with compressed autogenous PBCM. Oral rehabilitation was completed with a fixed bridge on two dental implants in the distal part of the graft. During the early follow-up, osteolysis at the mandibular angle and gradual resorption of the temporomandibular joint was observed. Long-term follow-up revealed stable incorporation of the graft with consolidation of defects. A class I occlusion and uninhibited maximum mouth opening remained present. Twenty years after reconstruction with the composite graft, the patient is very satisfied, with high functional success. This implies the composite graft can be a successful treatment option in specific cases of mandibular reconstruction.Level of evidence: Level V, therapeutic study.