Study on the hard tissue changes in osteomyelitis of the jaws using CT image

CT 영상을 이용한 악골 골수염의 경조직 변화에 관한 연구

  • An, Chang-Hyeon (Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, and Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University) ;
  • Choi, Bo-Ram (Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University) ;
  • Huh, Kyung-Hoe (Department of Oral and Maxillofacial Radiology, School of Dentistry and Dental Research Institute, Seoul National University) ;
  • Lee, Won-Jin (Department of Oral and Maxillofacial Radiology, School of Dentistry, Dental Research Institute and BK21, Seoul National University) ;
  • Lee, Sam-Sun (Department of Oral and Maxillofacial Radiology, School of Dentistry, Dental Research Institute and BK21, Seoul National University) ;
  • Choi, Soon-Chul (Department of Oral and Maxillofacial Radiology, School of Dentistry and Dental Research Institute, Seoul National University)
  • 안창현 (서울대학교 치의학대학원 구강악안면방사선학교실, 경북대학교 치의학전문대학원 구강악안면방사선학교실) ;
  • 최보람 (서울대학교 치의학대학원 구강악안면방사선학교실) ;
  • 허경회 (서울대학교 치의학대학원 구강악안면방사선학교실, 치학연구소) ;
  • 이원진 (서울대학교 치의학대학원 구강악안면방사선학교실, 치학연구소 및 BK21) ;
  • 이삼선 (서울대학교 치의학대학원 구강악안면방사선학교실, 치학연구소 및 BK21) ;
  • 최순철 (서울대학교 치의학대학원 구강악안면방사선학교실, 치학연구소)
  • Published : 2009.09.30

Abstract

Purpose : To assess the clinical findings and hard tissue changes of osteomyelitis of the jaws using computed tomographic (CT) image analysis. Materials and Methods : We reviewed and interpreted the CT images of 163 patients (64 males and 99 females, age range from 10 to 87 years) who visited the Seoul National University Dental Hospital from April 23, 2006 to December 31, 2008 and were diagnosed as osteomyelitis of the jaws through clinical, radiologic, and histopathologic examination. Each CT findings was investigated for frequency, correlation with age and gender. Results : Of the 163 patients, 31 (19.0%) were affected on the maxilla, 135 (82.8%) were affected on the mandible, and 3 (1.8%) were affected on the both jaws simultaneously. The mean age of the patients who were affected on the maxilla was 61.0 years and that of the patients who were affected on the mandible was 56.2 years. On the maxilla, the most frequent site of disease was the posterior area (83.9%) and on the mandible, mandibular body (83.0%), followed by angle (48.1%), ramus (38.5%), condyle (13.3%), incisal area (9.6%), and coronoid process (3.0%). Among the 31 maxillary osteomyelitis, defect in the trabecular bone was observed in 28 (90.3%), osteosclerosis 20 (64.5%), defect in the cortical bone 27 (87.1%), sequestrum 17 (54.8%), and periosteal reaction 2 (6.5%). Among the 135 mandibular osteomyelitis, defect in the trabecular bone was observed in 100 (74.1%), osteosclerosis 104 (77.0%), defect in the cortical bone 116 (85.9%), sequestrum 36 (26.7%), and periosteal reaction 67 (49.6%). Conclusion : Of our cases, the maxillary osteomyelitis was visibly observed more frequently in females than males. The incidence is the highest in seventies (28.8%) and the lowest in teens (3.1%). The osteomyelitis of the jaws was observed more frequently in males than females before the age of 50, and observed more frequently in females after the age of 50. The most noticeable point was that the sequestrum was observed more often on maxillary osteomyelitis and the periosteal reaction was observed more often on mandibular osteomyelitis.

Keywords

References

  1. Lee YH, Ahn HK. Radiologic study of osteomyelitis of the jaw. Korean J Oral Maxillofac Radiol 1980; 10 : 15-28.
  2. Yoshiura K, Hijiya T, Ariji E, Sa'do B, Nakayama E, Higuchi Y, et al. Radiographic patterns of osteomyelitis in the mandible. Plain film/CT correlation. Oral Surg Oral Med Oral Pathol 1994; 78 : 116-24. https://doi.org/10.1016/0030-4220(94)90127-9
  3. Fullmer JM, Scarfe WC, Kushner GM, Alpert B, Farman AG. Cone beam computed tomographic findings in refractory chronic suppurative osteomyelitis of the mandible. Br J Oral Maxillofac Surg 2007; 45 : 364-71. https://doi.org/10.1016/j.bjoms.2006.10.009
  4. Ida M, Watanabe H, Tetsumura A, Kurabayashi T. CT findings as a significant predictive factor for the curability of mandibular osteomyelitis: multivariate analysis. Dentomaxillofac Radiol 2005; 34 : 86-90. https://doi.org/10.1259/dmfr/23641620
  5. Hariya Y, Yuasa K, Nakayama E, Kawazu T, Okamura K, Kanda S. Value of computed tomography findings in differentiating between intraosseous malignant tumors and osteomyelitis of the mandible affecting the masticator space. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 95 : 503-9. https://doi.org/10.1067/moe.2003.134
  6. Tanaka R, Hayashi T. Computed tomography findings of chronic osteomyelitis involving the mandible: correlation to histopathological findings. Dentomaxillofac Radiol 2008; 37 : 94-103. https://doi.org/10.1259/dmfr/38320433
  7. Kaneda T, Minami M, Ozawa K, Akimoto Y, Utsunomiya T, Yamamoto H, et al. Magnetic resonance imaging of osteomyelitis in the mandible. Comparative study with other radiologic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79 : 634-40. https://doi.org/10.1016/S1079-2104(05)80107-6
  8. Seabold JE, Simonson TM, Weber PC, Thompson BH, Harris KG, Rezai K, et al. Cranial osteomyelitis: diagnosis and follow-up with In- 111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology 1995; 196 : 779-88.
  9. Schuknecht BF, Carls FR, Valavanis A, Sailer HF. Mandibular osteomyelitis: evaluation and staging in 18 patients, using magnetic resonance imaging, computed tomography and conventional radiographs. J Craniomaxillofac Surg 1997; 25 : 24-33. https://doi.org/10.1016/S1010-5182(97)80021-2
  10. Ariji Y, Izumi M, Gotoh M, Naitoh M, Katoh M, Kuroiwa Y, et al. MRI features of mandibular osteomyelitis: practical criteria based on an association with conventional radiography features and clinical classification. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105 : 503-11. https://doi.org/10.1016/j.tripleo.2007.04.029
  11. Park YW, Park JM, Jang JH, Kim JH, Kwon KJ, Lee SK. Squamous cell carcinoma arising from chronic osteomyelitis of the mandible. The Journal Of Korean Association of Maxillofacial Plastic and Reconstructive Surgeons 2008; 30 : 465-72.
  12. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004; 62 : 527-34. https://doi.org/10.1016/j.joms.2004.02.004
  13. Dimitrakopoulos I, Magopoulos C, Karakasis D. Bisphosphonateinduced avascular osteonecrosis of the jaws: a clinical report of 11 cases. Int J Oral Maxillofac Surg 2006; 35 : 588-93. https://doi.org/10.1016/j.ijom.2006.02.022
  14. Suei Y, Taguchi A, Tanimoto K. Diagnosis and classification of mandibular osteomyelitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100 : 207-14. https://doi.org/10.1016/j.tripleo.2004.11.006
  15. Bachmann G, Rossler R, Klett R, Rau WS, Bauer R. The role of magnetic resonance imaging and scintigraphy in the diagnosis of pathologic changes of the mandible after radiation therapy. Int J Oral Maxillofac Surg 1996; 25 : 189-95. https://doi.org/10.1016/S0901-5027(96)80027-0
  16. Lee SB, Huh KH, Yi WJ, Kim MJ, Lee SS. Osteomyelitis following extraction of lower third molar during pregnancy. Korean J Oral Maxillofac Radiol 2008; 38 : 177-82.
  17. Endicott JN, Nelson RJ, Saraceno CA. Diagnosis and management decisions in infections of the deep fascial spaces of the head and neck utilizing computerized tomography. Laryngoscope 1982; 92 : 630-3.
  18. Hardin CW, Harnsberger HR, Osborn AG, Doxey GP, Davis RK, Nyberg DA. Infection and tumor of the masticator space: CT evaluation. Radiology 1985; 157 : 413-7.
  19. Murphy JB, Ilacqua J, Bianchi M. Diagnosis of acute maxillofacial infections: the role of computerized tomography. Oral Surg Oral Med Oral Pathol 1985; 60 : 154-7. https://doi.org/10.1016/0030-4220(85)90283-X
  20. Nyberg DA, Jeffrey RB, Brant-Zawadzki M, Federle M, Dillon W. Computed tomography of cervical infections. J Comput Assist Tomogr 1985; 9 : 288-96. https://doi.org/10.1097/00004728-198503000-00011
  21. Ariji E, Moriguchi S, Kuroki T, Kanda S. Computed tomography of maxillofacial infection. Dentomaxillofac Radiol 1991; 20 : 147-51.