Management of a Case of Diffuse Sclerosing Osteomyelitis

Abstract

Definitively diagnosed disease-directed therapy leads to the rapid resolution of clinical illness and decreases the chances of developing chronic ailments. Appropriate diagnosis is crucial in initiating such therapies which can be made straightforward with the assistance of modern diagnostic aids. Osteomyelitis is an inflammatory disease of the bone and its marrow contents. This disease can have multifarious clinical and histopathologic presentations. Osteomyelitis of the jaws has proved to be a challenging condition to effectively diagnose, treat, and cure. However, there are various diagnostic aids which help in the identification of the condition. The diagnosis is usually based on a thorough evaluation of the patient history and clinical presentation, imaging techniques, culturing, and histologic analysis. Cone-beam computed tomography (CBCT) has proved to emerge as a promising diagnostic aid in relation to osteomyelitis. CBCT offers different views that give a clear insight into the extent of involvement of the disease. Treatment of this condition includes two lines of management – conservative approach and surgical approach. The conservative approach includes the use of antibiotics, hyperbaric oxygen therapy which improves the availability of antibiotics at the localized site, especially with the sclerosing variant. Surgical interventions are usually confined to the extraction of extremely mobile teeth, debridement of fragments of bone, and incision and drainage of fluctuant areas. Additional surgical procedures are considered if the infection persists, and these include sequestrectomy, saucerization, decortication, or resection followed by reconstruction. A case of diffuse sclerosing osteomyelitis arising from nonvital teeth managed using the surgical approach is presented here.

Keywords

• bone scintigraphy; cone-beam computed tomography; corticotomy; hyperbaric oxygen therapy; osteomyelitis