Diagnosis and management of chronic osteomyelitis and cemento-osseous dysplasia of the mandible Arifa Akram Tajinder Lidhar Katy Marie Valentine Roger Webb Dental Update 2024 46:11, 707-709.
Chronic osteomyelitis is a severe and persistent infection of the bone including the bone marrow. Cemento-osseous dysplasias are a group of conditions arising from the periodontal ligament tissue and are categorized into peri-apical, focal and florid. A case of a patient with buccal and submandibular swelling associated with a discharging sinus between LR45 was presented. History, examination and investigations confirmed a diagnosis of chronic osteomyelitis and an incidental finding of florid cemento-osseous dysplasia of the mandible. The patient's treatment is discussed within the context of important clinical considerations required in managing these patients.
CPD/Clinical Relevance: It is pertinent for a general practitioner to be aware of signs and symptoms associated with chronic osteomyelitis and understand the management options.
Article
A 67-year-old fit and well female of Nigerian origin was referred to the Accident and Emergency department by her general dental practitioner (GDP) with a one-week history of right-sided buccal and submandibular swelling. The patient complained of right-sided jaw pain, had mild trismus and an intra-oral discharging sinus in the buccal alveolus between the LR45. Furthermore, her dental history revealed that she had two dental extractions carried out in this sextant within the last year. An orthopantomogram (OPG) (Figure 1) and CT scan (Figure 2) demonstrated extensive erosion of the body of the mandible from the LR4 to LR6 region, which was predominantly lytic; reactive sclerosis of the adjacent bone and dense irregular bone fragments within the lytic areas, resembling sequestrum, was also noted. An incidental finding of dense sclerotic regions associated with the roots of these teeth, particularly localized to the lower left mandible and maxilla, was noted, showing features consistent with florid cemento-osseous dysplasia (FCOD). After discussion with the patient, surgical debridement and sequestrectomy of the right hemi-mandible were performed and specimens collected were sent for histological/microbiology examination.
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