Diffuse sclerosing osteomyelitis


Diffuse sclerosing osteomyelitis

Description, Causes and Risk Factors:

Diffuse sclerosing osteomyelitis is a different entity from the small, isolated lesions of focal sclerosing osteomyelitis. It is mainly confined to the mandible and it typically involves a large section of the bone.

Diffuse sclerosing osteomyelitis

Diffuse sclerosing osteomyelitis is a proliferative reaction in response to a low-grade inflammation or infection in the jaw bone. The infections in such cases are usually wide spread or diffuse in nature and are derived either from the periodontal tissue or from the periapical tissue.

The infections are usually subclinical in nature. Investigators have identified two bacteria in association with this disease, which are namely the Propionibacterium acnes and Peptostreptococcus (A genus of non-motile, anaerobic, chemoorganotrophic bacteria (family Peptococcaceae) containing spherical to ovoid, Gram-positive cells that occur in pairs and short or long chains. These organisms are found in normal and pathologic female genital tracts and blood in puerperal fever, in respiratory and intestinal tracts of normal humans and other animals, in the oral cavity, and in pyogenic infections, putrefactive war wounds, and appendicitis; they may be pathogenic. The type species is Peptostreptococcus anaerobius).

Symptoms:

    Diffuse sclerosing osteomyelitis is usually seen among elderly people.

  • It is mostly seen among blacks and racial groups.

  • More common among females.

  • Mandible is mostly affected in diffuse sclerosing osteomyelitis especially in edentulous areas. The disease can affect the maxilla as well and even sometimes all four quadrants of jaw could be affected at a time.

  • The disease is usually asymptomatic sometimes the patients may complain vague pain in the jaw with foul taste in mouth.

  • Acute exacerbation may occur in the lesion, which often products mild pain, suppuration and fistulas tract formation, etc.

  • SPAHO syndrome - it is a special entity characterized by chronic multifocal osteomyelitis with hyperostosis and osteitis of the bone. The condition is associated with negative bacterial culture and is non-responsive to antibiotic therapy.

Diagnosis:

    Radiograph shows areas of diffuse or nodular sclerosis of the bone. The appearance may be similar to the cotton-wool radiopacities seen in Paget's disease of bone. The border between the sclerotic bone and the normal bone is not well-demarcated.

  • Diffuse sclerosing osteomyelitis shows formations of dense irregular bone within a hypocellular fibrous stroma.

  • Bony trabeculae often reveal multiple reversal and resting lines.

  • Patchy distribution of chronic inflammatory cells is often found in the marrow tissue.

Differential diagnosis may include:

    Paget's disease.

  • Osteopetrosis.

  • Cementomas.

  • Gardener's syndrome.

  • Late stage of fibrous dysplasia.

Treatment:

No treatment is required as the disease is often asymptomatic and is too extensive for surgical removal. In case of acute exacerbations, surgical debridement and removal of the sequestrum is done along with antibiotic therapy.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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