Document Details
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Document Type |
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Article In Journal |
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Document Title |
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Diffuse sclerosing osteomylitis of maxilla and mandible review of literature and case report. التهاب العظم والنخاع المتكلس المنتشر بالفك العلوي والسفلي استعراض المنشور وتقرير عن حالة في هذا الموضوع |
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Document Language |
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English |
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Abstract |
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Sclerosing osteomyelitis of the mandible and maxilla has been
described as a special form of chronic osteomyelitis, which generally
starts from a low grade infection and manifests itself in the form of
multiple osteosclerotic areas (1) . The diseaRe i~ usually classifif'd
into focal and diffuse forms (2,3) . The focal type is more common
and known as condensing osteitis (3) . The diffuRe type is uncommon
and usually confined to the mandible(4).
Diffuse sclerosing osteomyelitis (DSO) is also known as : primary
chronic osteomyelitis (5) , nonsuppurative osteomyelitis (6) ,
osteomyelitis sicca (7), reactive hyperplasia of bone (8), sclerosing
osteitis (9) , osteosclerosis, enostosis, bone whorls, bone eburnation,
hyperostosis and ossifying osteomyelitis (10,11) .
The disease has a pronounced chronic course with repeated episodes
I)f pain, swelling and may be accompanied with trismus and
often resist antibiotic treatment. Mild suppuartion and chronic ulceration of the covering mucosa may occur. Systemic manifestations
are usually absent(1,2,9, 12).
The roentgenographic features of this condition are rather chara- cterized with ill defined osteolytic zones, irrigularily scattered in
more or less dense sclerotic bone. Periosteal deposition of bone can
be found especially during acute episodes and in younger persons (13) .
The radiopaque area may involve a considerable portion of the jaw,
with indistinct border between sclerotic and normal bone (3,8) .
Lebland and Leacock(9) followed several cases for a long period of
time and described in detail the roentgenographic and clinical changes
occurring in this disease. They noted that the early lesions
show, on roengenographic examination, a region of dense osteosclerosis
with rounded or lobulated margins and no signs of osteolytic
cha.nges. These changes tend to occur at a level in bone corre;:;ponding
to the roots of teeth. In the intermediate lesions, there is expansion
of the alveolar crest. Radiographpic examination reveals irrigular
.density and no osteolytic changes. In the late lesions, further alveolar
expansion occurs and infection develops, leadnig to osteolytic changes
seperating the lesion from surrounding bone and eventual sequestration
of the affected bone.
Microscopic examination of these lesions reveals marked proliferation
of dense, irrigular bone trabeculas. Some areas show active
osteoblasts, but «clastic)) cells were not observed. There is a redcution
in the marrow spaces, which are filled with loose fibrous tissue
containing variable numbers of inflammatory cells (3,8) .
The etiology is unknown, but is generally thought to be an
infection ,of low virulence, together with high host resistance (1,12) .
The raection of bone to injury is influenced by a unmber of factors;
including age of the patient, local blood supply, tissus resistance degree of injury. Occasionally, bone will react in an abnormal
way yo InJury; Robinson (14) has termed this altered reaction «ossta-
eous dysplasiaD.
Shafer(2) is of the openion that chronic sclerosing osteomyelitis
is a form of osseous dysplasia, the injurious agent being a form of
lowgrade, chronic, nonspecific infection.
Diffuse sclerosing osteomyelitis is relatively a rare disease and
occurrs most frequently in middle-aged and older persons. Females
are more frequently affected than males. It may occur in any race,
however, most of the reported cases were Negroes. The disease had
been reported to affect the mandible more frequently, but rarely the
maxilla may be involved(1-3,8,9,1l-13,15). Bell (1) in his review
of 5 cases, he noticed that they were all Negro females, in three cases
the mandible only was affected, while in the other two cases both
mandible and maxilla were involved.
J accobson (4) followed up 21 cases of diffuse sclerosing osteomyelitis
they were all affecting the mandible,. Waldron (8) followed
38 cases, he reported only 3 of them involving maxilla.
'l'reatment therapy remains a problem because of insufficient
understanding of the etiology. Different lines of treatment have
been tried, including antibiotics (3,6) , decortication (5) , and hyperbaric
oxygen (16) . |
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ISSN |
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0 |
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Journal Name |
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EGYPTIAN DENTAL JOURNAL |
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Volume |
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34 |
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Issue Number |
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4 |
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Publishing Year |
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1988 AH
1988 AD |
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Article Type |
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Article |
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Added Date |
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Sunday, November 8, 2009 |
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Researchers
| زينب عبداللطيف | abdulatef, zenab | Researcher | Doctorate | |
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