200 Australian Dental Journal 2005;50:3.
Chronic suppurative osteomyelitis of the mandible: Casereport
SC Yeoh,* S MacMahon,† M Schifter‡
Osteomyelitis of the maxillofacialskeleton is rare in developed countries such asAustralia. This case report describes the successfulsurgical treatment of chronic suppurativeosteomyelitis (CSO) of the mandible in a 75 year oldman. The precipitant factor was thought to be aretained tooth root in the (right) posterior body of the mandible.
Treatment included a pre-surgical courseof antibiotics (clindamycin 300mg, p.o. q.i.d. fortwo weeks) followed by removal of the retainedroot, surgical débridement of the affected bone, theintra-oral draining sinus, and resection of thecutaneous sinus tract. Specimens were taken forbacterial cultures and antibiotic sensitivity testing,and the resected tissue sent for histopathologicalreview.
On clinical and radiographic review at threemonths, the patient was well, completely symptomfree and the osteomyelitis had fully resolved.
This case report demonstrates thetypical features of CSO. The combination of antibiotic therapy and surgical débridement waseffective in the treatment of chronic suppurativeosteomyelitis of the mandible utilizing intravenoussedation, and so averting the need for a generalanaesthetic.
Osteomyelitis, chronic, surgery, clindamycin,débridement.
Abbreviations and acronyms:
CSO = chronic suppurativeosteomyelitis; p.o. = per oral (by mouth); q.i.d. = quarterin die (four times a day).
(Accepted for publication 5 November 2004.)
Osteomyelitis of the maxillofacial skeleton, inparticular, of the mandible is rare in developedcountries such as Australia. Osteomyelitis is aninflammation of bone and bone marrow that developsin the jaws usually after a chronic infection.
It may beclassified as acute, subacute or chronic, depending onthe clinical presentation. This decline in prevalence canbe attributed to the increased availability of antibioticsand the progressively higher standards of oral anddental health. Despite these advances, there remainselect groups of patients who have an increased risk of developing osteomyelitis: specifically those who haveundergone radiotherapy affecting the mandible (whichmay result in a specific form of osteomyelitis termedosteoradionecrosis), and the immunocompromised,
including uncontrolled diabetics, and patients onimmunosuppressive therapy, such as high dosecorticosteroids, needed for transplant recipients and thetreatment of auto-immune disorders.As the general population ages and retain their teethfor longer, combined with the declining availability of oral health professionals, particularly in the publicsector, as well as in remote rural and regional centres, itis thought that the incidence of osteomyelitis mayincrease. Therefore, dentists will need to be aware of clinical features and management of this uncommondisease.The primary cause of chronic osteomyelitis of thejaws is infection by odontogenic microorganisms.
Itmay also arise as a complication of dental extractionsand surgery, maxillofacial trauma and the subsequentinadequate treatment of a fracture, and/or irradiationto the mandible.
The typical age of presentation is in the fifties to thesixties, with males more likely to be affected. Thecommonest site is the posterior body of the mandible.The incidence, outside of those who have received headand neck radiotherapy and the immunocompromised,is increased in patients who have poor oral hygiene andare abusers of alcohol or tobacco.
CSO can develop without an intervening acutephase. Some authors have suggested that osteomyelitismust be present for at least one month before it is
*Registrar, Oral Medicine/Oral Pathology, Department of OralMedical and Surgical Sciences, Westmead Centre for Oral Health,Westmead Hospital, Westmead, NSW.†Visiting Oral Surgeon, Department of Oral Medical and SurgicalSciences, Westmead Centre for Oral Health, Westmead Hospital,Westmead, NSW.‡Head, and Staff Specialist (Oral Medicine), Department of OralMedical and Surgical Sciences, Westmead Centre for Oral Health,Westmead Hospital, Westmead, NSW.
Australian Dental Journal 2005;50:(3):200-203