Mandibular Osteomyelitis as the Earliest Clinical Manifestation of Maxillary Sinus Lymphoma.

Extranodal natural killer/T-cell lymphoma is a distinct subtype of non-Hodgkin lymphoma that originates from natural killer cells or cytotoxic T cells. Its diagnosis is challenging due to the rarity and lack of awareness, especially in cases where osteomyelitis of the jawbone is the initial symptom. This paper reports a case of extranodal natural killer/T-cell lymphoma presenting primarily with oral ulcers. Through analyzing the clinical and pathological characteristics, differential diagnosis, treatment and prognosis, and reasons for misdiagnosis of the disease, this study aims to provide references for clinical diagnosis and treatment.

Glandular odontogenic cyst misdiagnosed and treated as a periapical inflammatory lesion for 6 years in an older adult.

OBJECTIVES: To document the case of a patient who underwent several endodontic treatments due to a glandular odontogenic cyst misdiagnosed as an inflammatory periapical lesion. BACKGROUND: Glandular odontogenic cysts behave more aggressively, while others have an indolent course. There is limited information on this cyst in the gerodontologic literature. MATERIALS AND METHODS: A 76-year-old male patient presented with an asymptomatic expansive lesion in the anterior mandible resistant to several endodontic treatments. Cone-beam computed tomography revealed a multilocular osteolytic lesion measuring 6.0 × 4.0 cm, with cortical bone perforation. RESULTS: Histopathological analysis of a biopsy specimen was consistent with glandular odontogenic cyst. The patient underwent marginal mandibulectomy with preservation of the base of the mandible. CONCLUSION: A strict diagnostic process is important to avoid unwanted consequences, particularly in the geriatric population.

Use of Marsupialization as a Definitive Treatment for Large-sized Dentigerous Cysts in a Patient with Mucopolysaccharidosis Type I.

The correct diagnosis is fundamental for the appropriate treatment to be employed in a particular pathology. The best treatment is not the one that solves only local problems, fragmenting the patient, and therefore, it is necessary to integrate the entire systemic condition of the individual before initiating any local treatment. This context inevitably requires dentistry to participate in a multidisciplinary approach, where the role of the dentist is expanded in concepts that encompass ethics, human dignity, and professional valorization. This article describes a clinical case of a patient with mucopolysaccharidosis type I, whose treatment of cystic lesions present in the mandible was exclusively performed through marsupialisation. The objective of this study is to demonstrate, within the complexity of this rare syndrome, the difficulties of diagnosis and the need for evaluation of the patient beyond the limits of the oral cavity, as well as to report two cases of large dentigerous cysts, surgically treated conservatively through marsupialisation, without the need for re-approach for enucleation and without recurrences over a 20-year period.

Comparison of the histopathological characteristics of diffuse sclerosing osteomyelitis of the mandible, chronic suppurative osteomyelitis, and craniofacial fibrous dysplasia.

BACKGROUND: There are relatively few reports on the histopathological characteristics of diffuse sclerosing osteomyelitis of the mandible (DSOM), which is difficult to distinguish from chronic suppurative osteomyelitis (CSO) and craniofacial fibrous dysplasia (CFD). This study aimed to summarize and compare the histopathological characteristics of DSOM, CFD, and CSO. MATERIALS AND METHODS: In this study, hematoxylin and eosin-stained sections of patients with DSOM, CSO, and CFD at the Peking University Hospital of Stomatology from 2015 to 2020 were retrieved. The histopathological characteristics were summarized, including new bone formation, inflammatory cell infiltration, bone trabecular morphology, osteoclasts, sequestrum, bacterial mass, and calcified spherules, similar to cementicles. The histopathological characteristics of DSOM, CSO, and CFD were compared, and the results were statistically analyzed. RESULTS: In total, 50, 13, and 10 patients with DSOM, CSO, and CFD were included in this study, respectively. In terms of new bone formation, both DSOM and CSO showed reactive bone formation (p = 1), whereas CFD mainly showed fiber osteogenesis (p < 0.001). The inflammatory cells of DSOM were mainly lymphocytes and plasma cells, whereas those of CSO were mainly lymphocytes and neutrophils (p < 0.001), and there was usually no inflammatory cell infiltration in the CFD specimens (p < 0.001). DSOM, CSO, and CFD showed irregular bone trabeculae (p = 0.045, p = 0.703) and active osteoclasts (p1 = 0.189, p2 = 0.256). DSOM showed a small amount of bacterial mass but no sequestrum; neither of which was found in CFD (p = 1, p = 1), but it was common in CSO (p = 0.011 and p = 0.025). DSOM and CSO showed smooth and regular basophilic lines (p = 0.308), whereas CFD showed a rough and irregular basophilic line (p < 0.001). CONCLUSIONS: The histopathological characteristics of the three diseases were partly similar, but there were evident differences. The main differences are the type of new bone formation, types and distribution of inflammatory cells, and presence of sequestrum and bacterial masses. These differences will help clinicians diagnose DSOM.

[Radiolucency at both lower third molars: the paradental cyst]. / Radiolucentie bij beide derde ondermolaren: een paradentaire cyste.

A 23-year-old man presented with an irritating sensation at the third molar on the left side of the mandible and a bad taste in his mouth. Radiographic and histopathological examination revealed the abnormality was caused by a paradental cyst. The paradental cyst is located distal to a lower third molar and, together with the mandibular buccal bifurcation cyst, belongs to the inflammatory collateral cysts. Treatment consists of enucleation of the cyst and removal of the lower third molar. Recurrences do not occur.

An unusual case of double stafne bone cavities.

Stafne bone cavity (SBC) is a rare lingual bone depression that is asymptomatic and contains salivary glands. Radiographically, an SBC is usually seen as well-defined homogenous oval radiolucency in the mandibular posterior region, below the mandibular canal. In this paper, a rare case of posterior-variant, double SBCs was presented. A 43-year old male patient was referred to our clinic with the complaint of third molar teeth. Panoramic and cone-beam computed tomographic images showed two well-defined oval radiolucencies on the left mandibular molar region, inferior to mandibular canal borders. No pain or swelling was detected in the region of the radiolucencies. Previous dental radiographs had the same images. Magnetic resonance imaging was performed to evaluate the presence of salivary gland in the radiolucent contents. Images showed that the bone cavities were filled with soft tissue having a signal similar to the submandibular gland. The diagnosis was made as double SBCs and the patient was informed about the lesions.

Dental assessment of odontogenic maxillary sinusitis, aided by Cone Beam Computed Tomography.

OBJECTIVES: To identify tooth diseases as potential causative factors in the development of maxillary sinus lesions, with the aid of clinical examination combined with Cone Beam Computed Tomography (CBCT), in the patients with persistent sinus-like ailments, unresponsive to routine treatment offered by otolaryngologists. MATERIALS AND METHODS: In 44 patients with suspected odontogenic maxillary sinusitis, a dental examination with tooth vitality test was carried out, in conjunction with CBCT. The study involved 29 women and 15 men (age range 19-69 years, mean age 43 (SD = 13.9) years). RESULTS: In 15 (34.1%) patients the odontogenic lesions were encountered in maxillary sinuses. A total of 33 causative teeth were identified, of which 13 (39%) were after root canal treatment (RCT). Only one of the teeth had a properly reconstructed crown, and only one tooth had the root canals properly filled-in. Most frequently, the lesions in the sinuses were attributed to the inflammation of periapical tissues; the first molar having been established as the most common causative tooth. CONCLUSIONS: A detailed dental examination, pursued in conjunction with CBCT analysis, allow to diagnose odontogenic maxillary lesions. The incidence of long-term ailments originating in the maxillary sinuses should prompt a detailed assessment of the teeth, especially those after RCT.

Metronidazole-induced encephalopathy caused by hyperbaric oxygen therapy in a patient with mandibular osteomyelitis.

Metronidazole (MNZ) is prescribed for the treatment of infection caused by anaerobic bacteria and protozoa. Metronidazole-induced encephalopathy (MIE) has been known to be a side-effect, although its onset ratio is unclear. However, to the best of our knowledge, MIE associated with hyperbaric oxygen therapy (HBO) has not been previously reported. Here, we present the case of a 68-year-old man with mandibular osteomyelitis who received metronidazole for 49 days and received five times HBO therapy. He visited our hospital for evaluation and treatment of peripheral neuropathy, speech disturbance, nausea, and disturbance of gait after 47 days of initiating metronidazole treatment. Brain magnetic resonance imaging revealed hyperintense lesions in the cerebellar dentate nuclei, which was consistent with MIE. The patient's ataxic symptoms improved in 15 days after the discontinuation of MNZ. This is the first report demonstrating case of MIE could be related with HBO, as far as we had searched.

Simple Bone Cyst Mimicking Stafne Bone Defect.

Stafne bone defects (SBDs) are asymptomatic lingual bony defects in mandible, which are usually detected as an incidental finding in plain radiographs. Similarly, simple bone cysts (SBCs) are most frequently found in posterior region of the mandible and also are asymptomatic. However, due to anatomical structures overlap in plain radiographs, there is a possibility of misdiagnosing SBD that often is diagnosed by presumptive diagnosis observed in plain radiograph. This report shows an unusual case that a SBC resembles a SBD.

Management of a Brain Abscess Presumably Caused by Radiation Osteomyelitis of the Mandible.

In this clinical report, we present the management of a brain abscess that was presumed to be caused by radiation osteomyelitis of the mandible. The patient underwent chemoradiotherapy for oropharyngeal carcinoma on the left side at the Department of Otolaryngology of our hospital in 2000. Local recurrence or metastasis did not occur post-treatment. In January 2009, the patient was diagnosed with radiation osteomyelitis of the mandible on the left side, complicated by a pathologic fracture. In July 2011, numbness occurred in the left upper extremity and the patient was transferred to the emergency center of our hospital. A computed tomography scan showed a tumor lesion in the brain that was diagnosed as a brain abscess by magnetic resonance imaging. Neurosurgeons performed burr hole drainage of the abscess, followed by administration of antibiotics. Although impaired fine movements of the left hand remain, progress has been relatively favorable with no recurrence of osteomyelitis or brain abscess post-surgery.

Mandibular aneurysmal bone cyst in an elderly patient: Case report.

OBJECTIVE: The article aims to highlight the challenge of establishing the presumptive aetiological diagnosis when unilocular or multilocular radiolucencies are identified in an elderly patient's jawbones. MATERIALS AND METHODS: A mandibular cyst-like lesion was identified in a 73-year-old patient. The therapeutic decision was cyst enucleation and grafting of the bone defect. RESULTS: The initial presumptive diagnosis was invalidated by the histopathological examination that revealed the features characteristic for the aneurysmal bone cyst. CONCLUSION: Aneurysmal bone cyst in an elderly patient is a rare condition.

Anterior lingual mandibular bone depression: differential diagnosis of periapical inflammatory disorders.

Lingual mandibular bone depressions mainly affect the posterior region of the mandible. Depressions in the anterior region are rare, frequently posing difficulties in diagnosis. The aim of this article is to present a case of an anterior lingual mandibular bone depression (ALMBD) that was radiographically superimposed on the roots of anterior teeth. A 43-year-old man was referred for evaluation of a slight depression on the lingual surface of the anterior mandible. The depression was associated with a well-defined radiolucent area superimposed on the roots of the right canine and incisors. All teeth in the area proved to be vital, and cone beam computed tomography (CBCT) revealed a lingual depression in the area. The final diagnosis was an ALMBD, and the patient underwent clinical and radiographic follow-up examinations for 22 months that revealed no alterations in the area. When anterior mandibular radiolucencies are superimposed on the roots of the adjacent teeth, ALMBDs should be considered in the differential diagnosis along with periapical cysts and granulomas. Radiographic and CBCT analyses are useful to avoid unnecessary endodontic and surgical approaches.

Mandibular Osteomyelitis Following Implant Placement.

PURPOSE: Mandibular osteomyelitis is relatively rare except in cases of osteoradionecrosis or medication-related osteonecrosis. The purpose of this case report is to highlight a rare but devastating complication of dental implant surgery. MATERIALS AND METHODS: The case of a patient who developed mandibular osteomyelitis after implant placement, which was resistant to long-term antibiotic therapy and required radical surgical treatment with fibular free flap reconstruction, is reviewed as is the related literature. RESULTS: The most frequent etiologies are odontogenic and traumatic; however, hematogenous spread also exists. It usually affects patients with systemic conditions, such as diabetes mellitus, malnutrition, malignancy, or immune deficiency. The infection is usually polymicrobial. Concerning dental implant complications, the literature is comprehensive on the mechanical etiologies of implant failure and the infectious etiologies of peri-implantitis. Mandibular osteomyelitis treatment is a long and challenging process requiring long-term antibiotic therapy and multiple surgeries. CONCLUSION: The pathophysiology and treatment of mandibular osteomyelitis are discussed.

Concomitant Suppurative Parotitis and Condylar Osteomyelitis.

Parotitis is a common occurrence in the immunocompromised, dehydrated, and malnourished patient as a result of dysfunctional ductal and parotid cells. Inflammation can be acute or chronic based on clinical history, and it can be suppurative based on the presence of micro or macro abscess formation within the substance of the gland. This report presents a case of concomitant condylar osteomyelitis and chronic suppurative parotitis in the setting of previous methicillin-susceptible Staphylococcus aureus foot infection. Ultimately, resection of osteomyelitis, drainage of parotid infection, and intravenous antibiotic therapy led to full resolution of the infection and symptoms. The final pathology of osteomyelitis of the temporomandibular joint and methicillin-resistant S aureus infection is an unusual consequence of chronic parotitis. The patient was restored with a total joint replacement approximately 3 months after resection with no recurrence of infection after 24 months.

Periostitis Ossificans Arising in the Mandibular Bone of a Young Patient: Report of an Unusual Case and Review of the Literature.

Periostitis ossificans, also known as Garré osteomyelitis, is a specific type of chronic osteomyelitis that forms new bone under the periosteum resulting from a periosteal reaction to chronic inflammation or infections. It commonly affects the mandible secondary to odontogenic infection. The therapeutic approach involves eliminating the infectious cause and antibiotic administration. This report describes an unusual case of periostitis ossificans arising from the mandible of an 11-year-old boy. The cause of infection was correlated with a lower right unerupted third molar, which had no obvious connection with the oral cavity. The histologic diagnosis was chronic osteomyelitis with proliferative periostitis. The patient has been followed for 1 year, without any evidence of recurrence. Periostitis ossificans can be diagnostically problematic, and various conditions must be considered in the differential diagnosis.

Osteomyelitis of the Mandibular Condyle: A Report of 2 Cases With Review of the Literature.

In the maxillofacial area, osteomyelitis generally involves the mandible more commonly than the maxilla. Osteomyelitis of the mandible more often than not is odontogenic in origin and the dentate part is usually affected. In this context, involvement of the condyle and coronoid processes is very rare. This report describes 2 unique cases of condylar involvement with osteomyelitis. In these cases, the etiologies were unknown and were successfully managed by condylectomy and antibiotics. A comprehensive review of the English-language literature showed only 18 cases of osteomyelitis of the condyle. Odontogenic, otologic, and tubercular causes were the most common causes of osteomyelitis of the condyle. Radiologically, the condyle usually appeared osteolytic and eroded in osteomyelitis and radionucleotide scans were helpful in localizing the inflammation site. In most cases, condylectomy with appropriate antibiotics was required to eliminate the disease.

Cervical Necrotizing Fasciitis of Odontogenic Origin and Hyperbaric Oxygen Therapy.

Necrotizing fasciitis (NF) is an infection of the soft tissues pathology with high mortality that spreads through the fascial planes and rarely seen in head and neck region. The cause of infection is often odontogenic problems. Broad-spectrum antibiotics, surgical debridement, and hyperbaric oxygen therapy (HBO) are important for the treatment of disease. We report a case of cervical NF in a 33-year-old woman who was treated with rapid surgical debridement and simultaneous HBO.

Mandibular Osteomyelitis and Cervical Lymphadenitis Due to Mycobacterium abscessus: Surgical Management of a Pediatric Cohort With a Shared Epidemiologic Exposure.

BACKGROUND: Mycobacterium abscessus has been implicated as the cause of various infections in the setting of healthcare-related "outbreaks." Mandibular osteomyelitis caused by M abscessus is exceedingly rare, with only 1 patient reported in the literature. The authors describe the surgical management of 12 pediatric patients with M abscessus-related mandibular osteomyelitis and cervical lymphadenitis caused by exposure to contaminated water at a regional dental clinic. METHODS: Following institutional review board approval, new suspected patients were reviewed and followed prospectively. A multidisciplinary team coordinated the surgical approach, antibiotic regimen, and follow-up for each patient. RESULTS: Twelve patients (median age 7.5 years) received treatment of M abscessus infection. Eleven had mandibular osteomyelitis and underwent debridement along with extraction of affected teeth. Eight had lymphadenitis and underwent excision of involved nodes. Four patients (in whom surgical debridement was considered inadequate) received antibiotic therapy with a regimen of amikacin, cefoxitin, and azithromycin for 4 months. Nine of 12 patients have been followed for a median of 5 months (range 1-11 months); no patient has evidence of persistent clinical infection. Three of 4 patients treated with amikacin have high-frequency hearing loss. CONCLUSIONS: The authors describe a pediatric cohort with mandibular osteomyelitis and cervical lymphadenitis due to M abscessus following pulpotomy at a single dental clinic. Diagnosis required a high index of suspicion. Patients in our series had resolution of infection even without antibiotic therapy, suggesting that early complete surgical debridement and removal of affected lymph nodes can be sufficient as a sole treatment modality.

Idiopathic condylar resorptions: 3-dimensional condylar bony deformation, signs and symptoms.

INTRODUCTION: Our aim was to describe 3-dimensional condylar deformation of the temporomandibular joint (TMJ) and symptoms and signs of temporomandibular dysfunction (TMD) in patients with idiopathic condylar resorption (ICR). METHODS: We included 25 patients with ICR and 25 controls. We performed cone-beam computed tomographic scans and analyzed condylar width, length, and height as well as the condylar axial angle and the condylar neck angle. TMJ cross sections were evaluated for degenerative characteristics and location of bony deformations. Furthermore, symptoms and signs of TMD were described in the ICR group. RESULTS: In the ICR group, we found statistically significantly reduced condylar width (mean difference, 2.0 mm), height (mean difference, 4.9 mm), and condylar axial angle (mean difference, 10.6°); 84% of the TMJs had a posterior condylar neck angle (control group, 22%). The most common degenerative changes were noncongruent shape of the condyle-fossa relationship (72%), condylar resorption (56%), and nonintact cortex (40%). More than 70% of the joints with bony deformations showed changes along the entire condylar head. Most patients with ICR showed symptoms and signs of TMD; nevertheless, 12% had no signs or symptoms of TMD. CONCLUSIONS: ICR in the TMJ changes the shape and reduces the size of the condyle. Deformity locations are unspecified, and the entire condyle is often affected. Most patients with ICR have signs or symptoms of TMD; however, a small group was asymptomatic and without clinical signs.

Emergent gingival cyst of the adult.

The gingival cyst of the adult is a relatively rare, benign odontogenic cyst that maintains an insidious growth rate. This article describes a case of a diminutive fibrotic overgrowth arising on the labial interproximal gingiva between the mandibular right canine and first premolar in a 68-year-old woman. Within 1 year, the lesion had increased in size and appeared vesicular. The morphologic changes warranted surgical excision and histopathologic review. The lesion was diagnosed as a gingival cyst. At a 4.5-month recall appointment, there was no evidence of recurrence. Early lesional detection can potentially mitigate mucogingival defects and improve clinical outcomes.