Response of Different Treatment Protocols to Treat Chronic Non-Bacterial Osteomyelitis (CNO) of the Mandible in Adult Patients: A Systematic Review

Abstract

(1) Background: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disease of finally unknown etiology, which can occur alone or related with syndromes (chronic recurrent multifocal osteomyelitis—CRMO; synovitis, acne, pustulosis, hyperostosis and osteitis syndrome—SAPHO). The involvement of the mandible is rather rare. (2) Methods: We carried out a systematic literature search on CNO with mandibular involvement, according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines, considering the different synonyms for CNO, with a special focus on therapy. (3) Results: Finally, only four studies could be included. A total of 36 patients were treated in these studies—therefore, at most, only tendencies could be identified. The therapy in the included works was inconsistent. Various therapies could alleviate the symptoms of the disease. A complete remission could only rarely be observed and is also to be viewed against the background of the fluctuating character of the disease. The success of one-off interventions is unlikely overall, and the need for long-term therapies seems to be indicated. Non-steroidal anti-inflammatory drugs (NSAIDs) were not part of any effective therapy. Surgical therapy should not be the first choice. (4) Conclusions: In summary, no evidence-based therapy recommendation can be given today. For the future, systematic clinical trials on therapy for CNO are desirable.

[18F]Fluoride Positron-Emission Tomography (PET) and [18F]FDG PET for Assessment of Osteomyelitis of the Jaw in Comparison to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): A Prospective PET/CT and PET/MRI Pilot Study

“…There is still no gold standard for diagnosis of OMJ [ 1 , 24 , 25 ]. We investigated a diagnostic workup using [18F]FDG-PET/MRI and [18F]fluoride-PET/CT in a cohort of patients with symptomatic OMJ to evaluate both, morphologic and metabolic changes of the jawbone.…”

“…The cohort consisted of six female patients (mean age 55.3 ± 10.0 years) with symptomatic OMJ, including secondary (infectious) and primary (non-infectious) chronic OMJ, who were prospectively enrolled at our institution between 2/2018 and 10/2020. As recommended, OMJ diagnosis was based on the clinical course and previous therapies [ 1 , 24 , 25 ]. All patient had nonspecific clinical complaints that required accurate diagnosis to localize the OMJ manifestation.…”

Long-Term Follow-Up of SAPHO Syndrome for 15 Years Led to a Diagnosis of Temporomandibular Joint Pain and Trismus

“…In the treatment, the symptoms improved noninvasively by using drugs such as NSAIDs and BP preparation. In previous reports on nonbacterial osteomyelitis, aggressive surgical treatment resulted in a relapse of symptoms and reports recommending noninvasive treatment [3,4]. To date, no definitive treatment method has been established, but noninvasive treatment methods such as those using drugs may be effective.…”

“…Usually, symptomatic treatment is provided for bone and joint lesions. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin and diclofenac sodium are effective [3,4]. Although SAPHO syndrome causes aseptic inflammation, secondary infections may occur from nearby tissues, and antibiotics such as azithromycin and doxycycline are mainly used.…”

Chronic recurrent multifocal osteomyelitis. A narrative and pictorial review

“…They show complete remission of skin and musculoskeletal manifestations. Other biologics include IL-1 blockers, IL-23, and IL-17 inhibitors with relatively promising results (11,36,54,(76)(77)(78)(79). Bisphosphonates are effective and well-tolerated.…”