Chronic recurrent osteomyelitis: A surgeon's enigma

Abstract

Background Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis. Methods A thorough workup which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti‐inflammatory with or without surgical debridement/adjuvant therapies. Correlation of our findings and treatment plan was done with evidence‐based literature and practice. Results Complete resolution of symptoms with radiographic evidence was achieved in both the cases. In the recurrence period, long‐term steroids, NSAIDs, antibiotics resulted in better outcomes. Conclusion The evidence‐based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom‐free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.

A comparison of the vancomycin calcium sulfate implantation versus fenestration decompression for the treatment of sclerosing osteomyelitis

“…However, the destruction of this kind of blood vessels will in turn promote the reconstruction of endosteal blood vessels and facilitate the formation of new bone [ 12 – 14 ]. Studies have reported that Staphylococcus aureus infection is the most common cause of sclerosing osteomyelitis [ 15 ]. Staphylococcus aureus will enter osteoblasts for long-term survival after infecting bone tissue, and form bacterial biofilm on the surface of the lesion.…”

Recurrent chronic suppurative osteomyelitis in the maxilla of a patient with diabetes mellitus and glucose‐6‐phosphate dehydrogenase deficiency

“…Osteomyelitis of the jaws is an extensive group of inflammatory conditions that affect the medullary portion of the bones with distinct clinical, radiographic, and etiological aspects 1 . Due to improvements in the population's oral health, together with pharmacological advances and early diagnosis, the number of cases of osteomyelitis of the jaws has been reduced over the years 2 …”

Local treatment of experimental mandibular osteomyelitis with an injectable biomimetic gentamicin hydrogel using a new rabbit model

“…Moreover, the lack of a standardized evidence‐based approach to antibiotic treatment of bone infection often leads to controversy regarding antibiotic selection, route of administration (intravenous versus oral), and duration of therapy 11 . This may account for inadequate patient outcomes and high recurrence rate 12 …”