The Case Report of Sclerosing Osteomyelitis Garre of the Mandible

Abstract

A 21 years old female patient reported with the complaint of face asymmetry, pain, acne and rash on the skin in the mental area of the lower jaw (right side) and became sick at the age 1.5 years old after face trauma. She has experienced 4 low-efficient operations for diagnosis correction. Preoperative examination by 3D CT showed sclerosing focies in mental area of the mandible. On the base of anamnesis, clinical signs (pain, enlarged mandibular bone tissue, skin diseases, and typical radiological picture) were strongly suspected Garre osteomyelitis associated with SAPHO syndrome. Subsequent computer simulation (stereolithographic model, 3D-printed) allowed planning surgery. In January 2018 was held operation with extraoral approach-partial resection and leveling of the sclerosed bone in the area of lesion (according to printed CT scan model), dissection of soft tissue scars after previously performed operations. In 5 days, the patient left hospital in good condition with recommendations for further examination, sanation of odontogenic infection, radiological control. This disease refers to atypical primary chronic forms of osteomyelitis and is rare in clinical practice of maxillofacial surgeons, especially in adults. Treatment consists of surgical and conservative phases. The prognosis is favorable, but syndrome is often persistent.

Garré's Sclerosing Osteomyelitis with Perimandibular Soft Tissue Inflammation and Fistula

“…1 This chronic form of osteomyelitis is usually asymptomatic without any signs of local inflammation. 2 The common organisms encountered in the disease process include Staphylococcus, Klebsiella, and Streptococcus, resulting in phases of remission and exacerbation. 2 The commonest cause is odontogenic infection but it can also occur in gunshot wounds, fractures, pyoderma, postoperative bone interventions, etc.…”

“…1 It is commonly associated with odontogenic infections in children and young adults. 1,2 The first case was reported in tibia 2 and Berger described this condition to affect mandible for the first time. 1 The common causative pathogens of this condition are Staphylococci, Klebsiella, and Streptococci.…”

“…1 The common causative pathogens of this condition are Staphylococci, Klebsiella, and Streptococci. 2 The underlying pathology is the periosteal reaction to inflammation and hence, precisely known as chronic osteomyelitis with proliferative periostitis. 1 This condition is usually nonsuppurative and asymptomatic without signs of inflammation.…”

“…1 This condition is usually nonsuppurative and asymptomatic without signs of inflammation. [2][3][4] The SAPHO-synovitis, acne, pustulosis, hyperostosis, osteitis-syndrome is characterized by the presence of osteomyelitis in other bones, arthritis, and skin diseases. 2 However, rare instances of this condition, resulting in abscess and fistula formation, are described in literature.…”

“…[2][3][4] The SAPHO-synovitis, acne, pustulosis, hyperostosis, osteitis-syndrome is characterized by the presence of osteomyelitis in other bones, arthritis, and skin diseases. 2 However, rare instances of this condition, resulting in abscess and fistula formation, are described in literature. 3,4 We report one such rare case of Garré's sclerosing osteomyelitis associated with unusual surrounding soft tissue inflammation and intramuscular abscess and fistula to skin.…”