Radiographic characteristics of chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible: A comparison with chronic suppurative osteomyelitis and osteoradionecrosis.

Diffuse sclerosing osteomyelitis (DSO) of the mandible is a poorly understood chronic disease. It is assumed to be a form of chronic osteomyelitis. Other forms of chronic osteomyelitis are chronic suppurative osteomyelitis (CSO) and osteoradionecrosis (ORN). This study aimed to investigate radiographic characteristics of DSO and compare these findings with the radiographic characteristics of CSO and ORN in order to radiographically distinguish these three diseases. In this retrospective study, 33 patients were clinically diagnosed with DSO (13), CSO (6), or ORN (14). The panoramic radiographs, computed tomography images, and magnetic resonance images of these patients were evaluated. Osseous and soft tissue changes were analysed. Patients with DSO showed extensive cortical and medullary sclerosis combined with subperiosteal bone formation, condylar process deformation, and hypertrophy and oedema of the masseter muscle. DSO patients showed no pathological fractures or sequestra, which were observed in patients with CSO and ORN. The radiographic characteristics that differentiate DSO from CSO and ORN include subperiosteal bone formation, condylar process deformation, masticatory muscle changes, and the absence of sequestra and pathological fractures.

Proliferative Periostitis in a Pediatric Patient.

Proliferative periostitis is a rare condition that can affect children and adolescents. It is characterized by the successive deposition of layers of bone caused by low-virulence infection or chronic inflammatory stimulation. The purpose of this paper is to report a case of proliferative periostitis in a pediatric patient, emphasizing the clinical and radiographic aspects as well as the therapeutic management.

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction.

Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction / Osteomielite crônica multifocal recorrente exibindo predomínio de reação periosteal

Summary Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.

Resumo Osteomielite crônica multifocal recorrente é uma desordem autoinflamatória óssea idiopática não piogênica, envolvendo vários sítios e com evolução clínica persistindo por mais de 6 meses, podendo apresentar episódios de remissão e exacerbação em longo prazo. Representa de 2 a 5% das osteomielites, com incidência aproximada de até 4/1.000.000, com idade média de apresentação estimada entre 8 e 11 anos, predominando no gênero feminino. Os membros inferiores são os mais afetados, com predileção para regiões metafisárias junto à fise. Descrevemos um caso da doença em uma menina de 2 anos e 5 meses de idade, com acometimento de ulna esquerda, mandíbula à direita e tíbia esquerda, exibindo predomínio de reação periosteal como achado principal.

Yaws Osteoperiostitis Treated with Single-Dose Azithromycin.

AbstractThe etiologic agent of yaws, Treponema pallidum subsp. pertenue, causes a multistage infection transmitted by nonsexual contact with the exudates from active lesions. Bone lesions in the form of osteoperiostitis are common and occur in numerous bones simultaneously in early stages. Although a multinational eradication campaign with mass administration of intramuscular benzathine benzylpenicillin in the 1950s greatly reduced its global incidence, a resurgence of yaws has occurred since around 2000 in western and central Africa and the Pacific Islands. The finding that a single oral dose of azithromycin (30 mg/kg) was as effective as benzathine benzylpenicillin prompted renewed interest by World Health Organization in 2012 toward eradication of this infection by 2020. We previously reported the excellent response to benzathine benzylpenicillin therapy for yaws osteoperiostitis. Herein, we document a confirmed case of yaws with osteoperiostitis successfully treated with single-dose azithromycin and discuss the pathology of yaws periostitis and comment on the implications of this in light of the new campaign toward yaws eradication.

Assessing the level of matrix metal proteinases 1,8,9, their tissue inhibitor, type I, in cases of odontogenic phlegmons.

The article considers the measured values of the level of MMP-1, MMP-8 and MMP-9, and of their tissue inhibitor Type I (TIMP-1) in the blood serum and mixed saliva samples of 78 patients (31 women - 36.2 %, 47 men - 63.8 %) suffering from odontogenic phlegmons in the oral and maxillofacial region. The study indicators were assessed through the enzyme-linked immunosorbent assay using diagnostic sets RandD Diagnostics Inc. (USA). An uncontrolled hyperactivation of metal proteinases as one of the components of the systemic inflammatory response in case of phlegmon-related complications in the oral and maxillofacial region, as well as development of the sepsis syndrome were studied and it was determined that it results in distortion of the processes of reparative hystogeny and compel us to employ new approaches to the treatment of this type of patients (Tab. 2, Fig. 1, Ref. 13).

Florid reactive periostitis in the fifth phalange of a professional boxer: A case report.

RATIONALE: Florid reactive periostitis is a rare, benign bone and chondrogenic lesion that develops most frequently in the phalanges of the hands. Although the definitive cause of florid reactive periostitis is unknown, the major inciting factor is generally considered to be trauma, including repetitive minor trauma. PATIENT CONCERNS: We present a case of florid reactive periostitis affecting two contiguous phalangeal bones of the left fifth phalange of a 23-year-old male professional boxer. The patient had experienced chronic pain around the metacarpophalangeal joint of the left fifth phalange when punching with the left hand; this pain was improved but not resolved after conservative treatment. INTERVENTIONS: Plain radiography of the fifth phalange revealed a bulging bone lesion on the volar side of the proximal phalanx and metacarpal of the left fifth phalange. Computed tomography also showed raised bony lesions on the volar side of these bones without bony destruction or intraregional calcification. Surgery was performed and histopathology revealed that the bone specimens comprised a mixture of fibrous connective tissue and relatively immature bone covered by bland osteoblasts. DIAGNOSES: These findings were suggestive of a benign bone formation process, and the lesion was diagnosed as florid reactive periostitis. OUTCOMES: The pain and tenderness in the left fifth phalange experienced during boxing had completely resolved by 6 months postoperatively, and 12 years postoperatively the patient had full range of motion and no recurrence of pain. LESSONS: Traction force, such as those associated with "leading jabs," may induce repetitive minor trauma and subsequent periosteal damage, resulting in the gradual development of bulging bone ridges on the volar surface of the proximal fifth phalange and metacarpus of the hand.

Pachydermoperiostosis.

A case of Pachydermoperiostosis (PDP) presented to us in rheumatology clinic with complaints of enlargement and broadening of bilateral hands and feet, grade IV digital clubbing, coarsening of facial features, excessive sweating of the palms, soles during summers.

Utilization of ethyl cyanoacrylate and 2-octyl cyanoacrylate adhesives for autogenous bone graft fixation: histomorphometric study in rats.

The present study analyzes the repair process of autogenous bone graft in a block fixed with ethyl cyanoacrylate and 2-octyl cyanoacrylate adhesives in rat calvaria. Forty-eight rats, divided into 3 groups, received round osteotomies at the right parietal bone for the attainment of autogenous bone graft fragment, which was fixed at the opposite side to the donor site with ethyl cyanoacrylate (ethyl group) and 2-octyl cyanoacrylate (octyl group) adhesives. In the control group, bone fragment was only juxtaposed at the parietal bone surface without any fixation material. The animals were euthanized after 10 and 60 postoperative days. The calvariae were processed in a laboratory for the attainment of slides stained through the hematoxylin and eosin technique for histological and histometric analysis. The qualitative analysis showed a discrete inflammatory infiltrate in the control group and moderate inflammatory infiltrate in the ethyl and octyl groups at the 10-day period, which remained at the 60-day period, mainly in the octyl group. The bone fragment remained bonded to the recipient site through the adhesive, but graft incorporation was not observed in any of the specimens. Resorption was higher in the octyl group followed by the ethyl and control groups, both at the 10- and 60-day periods, but with no statistical significance (P < .05). Although promoting graft fixation and its maintenance at the recipient site, both studied adhesives did not allow the graft incorporation, producing a localized and discrete inflammatory reaction, which persisted at 60 days, being more intense in the octyl cyanoacrylate group.

Florid reactive periostitis of the metacarpal and phalanx: 2 case reports.

Florid reactive periostitis is a rare benign fibro-osseous proliferative lesion of soft tissue and is mainly composed of fibrous connective tissue and mature bone. The lesion usually occurs in the finger and seldom in the metacarpal. The lesion mimics malignant and infectious disorders, thus often leading to inappropriate treatment. Radiography usually shows an ossified mass attached to the underlying hand bones without interruption of the cortex. We report 1 case of florid reactive periostitis with unossified mass and underlying bone marrow edema in the metacarpal of hand and 1 case with adjacent cortical destruction in the phalanx. In addition, we describe the imaging findings of computed tomography CT and magnetic resonance imaging MRI and discuss their diagnostic values compared with routine radiographic examination.

Dental disease in slender lorises (Loris tardigradus).

Necropsies were performed in 25 slender lorises (Loris tardigradus) from a colony at Bochum University. In seven adult individuals, teeth were missing, loose, or severely affected by dental calculus. In one of these cases, a severe periodontal disease was seen without abscess formation. In another four lorises purulent/gangrenous inflammation was found next to the teeth either in the maxillary or the mandibular region.

Complete form of pachydermoperiostosis: a case report.

Pachydermoperiostosis is a primary form of hypertrophic osteoarthropathy, which presents with pachydermia, digital clubbing, and radiologic periostosis. Pachydermoperiostosis occurs owing to mutations of the gene encoding for 15-hydroxyprostaglandin dehydrogenase (15HPGD). Clinical manifestations of PDP are thought to relate to excessive collagen formation and dysregulation of matrix proteins because of fibroblastic hyperactivation. We present a very rare case of the complete form of pachydermoperiostosis in a young Indian male.

Florid reactive periostitis ossificans of long bones and digits associated with reaction in a patient with leprosy.

Florid reactive periostitis ossificans is a rare bone lesion usually occurring in the small, tubular bones of the hands and feet. This entity is a benign and aggressive periosteal reaction associated with soft tissue swelling that appears similar to a bone lesion that radiographically and clinically mimics an infectious or neoplastic process. Typically the lesions occurs in an adolescent or young adult and presents as a small area of painful swelling and erythema over the affected bone. The cause of florid reactive periostitis ossificans is not exactly known though many authors have postulated varied etiopathogenesis for the same condition. In this report, is a very rare and unusual example of this entity that has been observed in association with erythema nodosum leprosum (ENL) a type 2 lepra reaction in a Leprosy patient.

Onycho-pachydermatit with extensive bone marrow edema predominant in the metacarpals: a "forme fruste" of POPP?

Psoriatic onycho-pachydermo-osteo/periostitis (POPP) syndrome is a rare form of psoriatic arthritis with a combination of (i) psoriatic onychodystrophy, (ii) connective tissue thickening, and (iii) periostitis of the distal phalanges. The treatment of the condition has generally been reported to be unsatisfactory with the traditional regimes. Here, we describe a case whom we believe is one presentation of POPP with extensive bone marrow edema of metacarpal bones without distinctive periostitis.

Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability.

PURPOSE: This study aims to compare the associated lesions, clinical results, and postoperative recurrence rates in patients with ALPSA lesions (ALPSA group) versus those with Bankart lesions or Perthes lesions (Bankart group) in arthroscopic capsulolabral repair for anterior shoulder instability. METHODS: Two hundred and twenty-two patients (227 shoulders) who had been followed for a minimum of 1 year were enrolled for this study. Mean age at the time of first dislocation was 19.5 ± 4.8 years. Mean age at the time of operation was 23.3 ± 4.6 years. One hundred and seventy-four shoulders were included in the Bankart group and fifty-three shoulders in the ALPSA group. RESULTS: The mean preoperative number of dislocations was significantly higher in the ALPSA group with 12.3 ± 6.2 times than in the Bankart group with 6.9 ± 5.7 times. No statistically significant differences were found in final clinical results except postoperative loss of external rotation (P < 0.01) between the two groups. The ALPSA group had significantly higher rates of the lesion extended to the superior part of the 2 o'clock position (P < 0.01), synovitis (P < 0.01), glenoid erosion (P < 0.01), large Hill-Sachs lesions (P < 0.01), and engaging Hill-Sachs lesions (P = 0.03). The recurrence rate was 15.1% in the ALPSA group, more than twice the rate in the Bankart group with 7.4% (P = n.s.). The size and engagement of Hill-Sachs were significantly associated with redislocation (P < 0.01, P = 0.02). CONCLUSIONS: Compared with the Bankart group, the ALPSA group showed a significantly higher number of preoperative dislocations, an associated larger-sized Hill-Sachs lesion, and a higher tendency to develop into an engaging Hill-Sachs lesion. In addition, the ALPSA group presented a higher tendency to redislocate and significant postoperative loss of external rotation after capsulolabral repair.

Osteoperiostitis in early yaws: case series and literature review.

We describe the clinical and radiological manifestations and outcome after treatment of 7 children who received a diagnosis of early yaws osteoperiostitis. Osteoperiostitis occurred some weeks after the primary infection, and the most common finding was hypertrophic periostitis of long bones. All treated patients had excellent responses to benzyl-penicillin therapy.