• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.2
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• pp.68-75
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• 2019

Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.10 no.1
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• pp.15-28
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• 1980

The author studied age and sex distribution, etiology, affected site and several radiographic features of osteomyelitis of the jaw. And radiologic classification of osteomyelitis was also done. The material consisted of 118 males and 96 females examined and/or treated under the diagnosis of osteomyelitis during past 11 years (1970-1980.6) in SNUDH. The obtained results were as followings. 1. The incidence is the highest in teenages(22.9%) and the lowest in seventies. (2.8%). 2. 199 cases were found in lower jaw, and 15 cases in upper jaw. 30.8% of all cases were located at the posterior portion of mandibular body comprising alveolar region. 3. Radiographic examination of osteolytic lesion revealed that 21. 5% of all patients had periapical and alveolar bone rarefaction combined with osteoporotic changes and that in most of patients two or more of the above described changes were present at the same time. 4. Sclerotic lesions were seen in 62.2 % of all patients and 21.5% of sclerotic lesion were diffuse or homogenuous type. 5. Based on the radiologic study, classification of the osteomyelitis of the jaw was made. Loclized osteolytic type was the highest in incidence (38.8%) and localized sclerotic type was the lowest (7.0%)

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.39.1-39.6
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• 2015

Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm. Panoramic, CT, and CBCT revealed bone resorption patterns in the left condyle. Through control of diabetes, continued pharmacological treatment, arthrocentesis, and occlusal stabilization appliance therapy were carried out. The extent of active mouth opening was increased to 45 mm, and pain in the left jaw joint was alleviated. This was a case wherein complications caused by failure to control diabetes induced skull-base osteomyelitis. There is a need for continued discussion about the advantages and disadvantages of arthrocentesis with lavage for patients with skull-base osteomyelitis and other treatment options.

• Journal of Oral Medicine and Pain
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• v.47 no.4
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• pp.212-216
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• 2022

Osteomyelitis in the oral and maxillofacial area is a relatively uncommon inflammatory disease that occurs due to odontogenic causes such as endodontic infection, facial trauma, insufficient blood supply caused by some medical conditions, and iatrogenic postoperative infections. Among them, the incidence rate of candida osteomyelitis in this area is minimal; therefore, no consensus on the diagnosis, treatment, and prognosis has not been established yet. With the increasing number of immunocompromised elderly patients, candida osteomyelitis of the jaw is expected to become more prevalent. In this case report, we present an 81-year-old male patient with candida osteomyelitis of the jaw, including the maxillary and ethmoid sinuses.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.1
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• pp.33-41
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• 2007

Bone scan using radioactive isotope can be more effective than conventional X-ray radiograph for finding jaw lesion because it takes an image of the physiologic change of bone. This study is designed to show how available bone scan is able to diagnose jaw lesion better than simple X-ray and CT, as well as to determine a basis of diagnosis for jaw lesion using bone scan. The 77 patients, visiting the Oral & Maxillofacial Surgery, Department of Dankook University Hospital from January 2002. to August 2005. who were diagnosed histopathologically with postoperative malignant tumor, osteomyelitis, and bone infiltrative benign disease. Preoperative X-ray, CT, bone scan were taken and were compared with histopathologic finding. Also to compare specificty of each lesion in bone scan, bone density was measured to compare. The results were as follows. 1. Among the 25 cases of oral malignant tumor of bony invasion, a positive diagnosis associated with histopathologic evaluation, 22 cases(88%) in bone scan, 14 cases(56%) in CT image, and 10 cases40%) in simple X-ray. 2. Among the 31 cases of osteomyelitis, a positive diagnosis associated with histopathologic evaluation, 30 cases(97%) in bone scan, 23 cases(74%) in CT image, and 19 cases(61%) in simple X-ray. 3. Among the 11cases of bone infiltrative benign disease, a positive diagnosis associated with histopathologic evaluation, 11 cases(100%) in bone scan, 10 cases(91%) in CT image, and 6 cases(55%) in simple X-ray. 4. Measurement of bone density in each group showed no statistical significant difference between malignant tumor and osteomyelitis as well as benign bone disease. But, a statistical significance was seen between osteomyelitis and benign bone disease. From this results, bone scan are more sensitive than simple X-ray and CT image in jaw lesion diagnosis, but specificity shows no significant difference. Therefore, it should be suggested that evaluation of bone scan must be carrying out in reference to final histopathologic diagnosis.

• Imaging Science in Dentistry
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• v.32 no.2
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• pp.81-87
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• 2002

Purpose : To investigate the diagnostic significance of cortical changes in the bone of diseased jaws utilizing computed tomography (CT). Materials and Methods: Computed tomographic images of 91 patients, consisting of 7 osteomyelitis, 46 cysts, 18 benign tumors, and 20 malignant tumors, were analyzed. The pattern of cortical expansion was classified into three types: no expansion (N), buccal or lingual expansion (B/L), and buccolingual expansion (B & L). The pattern of cortical destruction was classified into four types: no destruction (N), point destruction (PO), gross destruction (GR), and permeative destruction (PE). The pattern of periosteal reaction was classified into four types: parallel, irregular, spicule, and Codmans triangle. The relationship between the pattern of cortical bone changes and diseases of the jaws was assessed. Results: When the pattern of cortical expansion was compared to diseases of the jaw, N-type was most prevalent in cases of osteomyelitis and malignant tumors, B/L-type with cysts, and B&L-types with benign tumors. Comparison between the pattern of cortical bone destruction with diseases of the jaw showed strong correlations between PO and PE-types to osteomyelitis, N-type with cysts, N and GR-types with benign tumors, and GR-type with malignant tumors. Finally, the relationship between the pattern of periosteal reaction to diseases of the jaw showed a strong correlation between parallel-type to osteomyelitis and spicule-type to malignant tumors. Conclusion : The pattern of cortical expansion and cortical destruction is useful in differentiating diseases of the jaws.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.6.1-6.10
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• 2019

Background: Osteomyelitis is an intraosseous inflammatory disease characterized by progressive inflammatory osteoclasia and ossification. The use of quantitative analysis to assist interpretation of osteomyelitis is increasingly being considered. The objective of this study was to perform early diagnosis of osteomyelitis on digital panoramic radiographs using basic functions provided by picture archiving and communication system (PACS), a program used to show radiographic images. Methods: This study targeted a total of 95 patients whose symptoms were confirmed as osteomyelitis under clinical, radiologic, pathological diagnosis over 11 years from 2008 to 2017. Five categorized patients were osteoradionecrosis, bisphosphonate-related osteonecrosis of jaw (BRONJ, suppurative and sclerosing type), and bacterial osteomyelitis (suppurative and sclerosing type), and the control group was 117 randomly sampled. The photographic density in a certain area of the digital panoramic radiograph was determined and compared using the "measure area rectangle," one of the basic PACS functions in INFINITT PACS^® (INFINITT Healthcare, Seoul, South Korea). A conditional inference tree, one type of decision making tree, was generated with the program R for statistical analysis with SPSS^®. Results: In the conditional inference tree generated from the obtained data, cases where the difference in average value exceeded 54.49 and the difference in minimum value was less than 54.49 and greater than 12.81 and the difference in minimum value exceeded 39 were considered suspicious of osteomyelitis. From these results, the disease could be correctly classified with a probability of 88.1%. There was no difference in photographic density value of BRONJ and bacterial osteomyelitis; therefore, it was not possible to classify BRONJ and bacterial osteomyelitis by quantitative analysis of panoramic radiographs based on existing research. Conclusions: This study demonstrates that it is feasible to measure photographic density using a basic function in PACS and apply the data to assist in the diagnosis of osteomyelitis.

• Korean Journal of Microbiology
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• v.53 no.2
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• pp.126-128
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• 2017

Cutibacterium acnes (formerly Propionibacterium acnes) is an anaerobic, Gram-positive rod and that is a normal flora of human skin and mucosal surface as well as an opportunistic pathogen related to acnes vulgaris, sarcoidosis, brain abscess, endocarditis, periodontitis, and endodontic infections. C. acnes KCOM 1861 (= ChDC B594) was isolated from a human jaw osteomyelitis lesion. Here, we present the complete genome sequence of C. acnes KCOM 1861.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.6
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• pp.470-476
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• 2011

Introduction: The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has increased gradually in patients who have undergone surgical treatment for osteomyelitis. In this study, a retrospective analysis of BRONJ patients was carried out using the data of osteomyelitis patients treated surgically. Materials and Methods: Osteomyelitis patients, who underwent curettage, sequestrectomy, saucerization or decortications, and partial mandibulectomy at Seoul National University Dental Hospital from 2004 to 2010 were enrolled in this study. The patients were classified and categorized into two groups based on the surgical records and progress notes. One group comprised of patients with osteomyelitis and osteoporosis, and the other group included patients with osteomyelitis only. The epidemiological data of the BRONJ patients was analyzed to identify any trend in the incidence of BRONJ in osteomyelitis patients. Results: Among 200 patients who underwent surgical intervention for osteomyelitis, 64 (32.0%) were identified as having osteoporosis as the underlying disease. In these 64 patients, more than 81.3% had been prescribed bisphosphonates. Females were far more affected by BRONJ than males. The incidence of BRONJ also increased with age. The posterior part of the mandible was affected more frequently by BRONJ. Conclusion: Although the availability of potent antibiotics and increased oral hygiene care can reduce the overall incidence of osteomyelitis, BRONJ can increase the total incidence. To prevent BRONJ, it is recommended that an oral examination be performed before prescribing bisphosphonates. Moreover, the patients should be educated about the potential risks of dental procedures that might be causal factors for BRONJ. Furthermore, patient swho take bisphosphonates for the treatment of osteoporosis should undergo periodic follow up oral examinations to prevent BRONJ.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.6
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• pp.332-337
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• 2015

Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment.