Sclerosis in bisphosphonate-related osteonecrosis of the jaws and its correlation with the clinical stages: study of 43 cases.

We analysed the degree of sclerosis in the different stages of bisphosphonate-related osteonecrosis of the jaws (BRONJ) and studied the relation between the grade of sclerosis, the clinical symptoms, and the depth of lucency. We compared 43 patients with mandibular BRONJ with a control group of 40 cases with no bony lesions. The presence of sclerotic bone, cortical irregularities, radiolucency, fragmentation or sequestration, periostitis, and narrowing of the mandibular canal were studied from computed tomographic (CT) scans using the program ImageJ 1.47v (National Institute of Health, Bethesda, USA) to measure the radiolucency, width of the cortices, and degree of sclerosis. Patients with BRONJ had more severe sclerosis than controls (p<0.01). There was also a significant difference among the different stages of BRONJ, with the highest values found in stage III (p=0.02). The degree of sclerosis differed according to sex, type of bisphosphonate, and the clinical characteristics such as pain, or suppuration, but not significantly so (p>0.05). We conclude that the degree of sclerosis increases with the clinical stage of BRONJ, and is correlated with the depth of lucency.

O papel do periósteo nos procedimentos ortopédicos como exemplo de sua capacidade reparatória / The role of the periosteum in orthopedic procedures: an example of its reparative ability

Na Ortopedia, o periósteo adquire relevância por estar associado à morfologia óssea, que pode ser modificada pelas demandas funcionais, contribuindo enormemente com o dinamismo oferecido pela remodelação, ou turnover, óssea. Estudar mais profundamente a capacidade adaptativa, reacional e reparatória do periósteo nos permite entender: 1) o comando dos osteócitos na determinação da morfologia óssea, inclusive durante o movimento dentário induzido; 2) a expansão rápida do palato e as mudanças ocorridas na forma da maxila; 3) o deslocamento mandibular por aparelhos ortopédicos funcionais; 4) a etiopatogenia da periostite ossificante, antigamente denominada de osteomielite de Garrè; 5) a “expansão” das corticais durante os crescimentos císticos e tumorais. Nesse trabalho, discorre-se sobre os eventos celulares e teciduais das reações periosteais e suas extrapolações clínicas.

Periostitis ossificans (Garrè's osteomyelitis) radiographic study of two cases.

BACKGROUND: Periostitis Ossificans (PO) is a non-suppurative type of Osteomyelitis, commonly occurring in children and young adults, in mandible. The most common cause for PO is periapical infection of mandibular first molar. Radiographically PO is characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic appearance of "onion skin". CASE REPORTS: Two male children 11 years of age reported to the Department of Oral Medicine with a painless and persistent bony hard swelling in the mandible, with a short duration (Figs 1, 5). Both the patients had grossly decayed mandibular permanent first molar tooth with periapical infection and buccal cortical plate expansion (Figs 2, 6). The radiographic study revealed different appearances, the Orthopantomograph of case I showed a single radiopaque lamella outside the lower cortical border, without altering original mandibular contour (Fig. 3) and in case II showed a newly formed bony enlargement on the outer aspect of the lower cortical border without altering the original mandibular contour (Fig. 7). Occlusal radiograph of both the patients showed two distinct radiopaque lamellae of periosteal bone outside the buccal cortex (Figs 4, 8). Kawai et al. classified PO of mandible into type I and type II, based on whether the original contour of mandible is preserved or not. Each type is further classified into two sub types (Table 1). In case I, the orthopantomographic appearance is characteristic of type I-1 (Fig. 3), but the appearance in occlusal radiograph is characteristic of type I-2 (Fig. 4). In case II, the appearances in both the radiographs are characteristic of type I-2 (Figs 7, 8). CONCLUSIONS: Apart from the typical onion skin appearance, PO shows various other radiographic appearances. The radiographic appearance of Periostitis Ossificans may reflect the duration, progression and the mode of healing of the disease process. The radiographic classification of PO depends on the type of radiographs taken for evaluation.

Gross periostitis ossificans in mandibular osteomyelitis. Review of the English literature and radiographic variation.

OBJECTIVE: The purpose of this study was to describe a radiographic variety of gross periostitis ossificans in mandibular osteomyelitis and to determine what types of gross periostitis ossificans are related to a specific form of mandibular osteomyelitis without demonstrable causes. STUDY DESIGN: We reviewed 20 cases of gross periostitis ossificans in patients with mandibular osteomyelitis that had been reported with illustrations in the English literature, and we reviewed our own 14 cases of gross periostitis ossificans, previously reported. The radiographic features of the 34 cases of gross periostitis ossificans were classified according to the status of original contour and the appearance of gross periostitis ossificans. Histopathologic features were studied in 12 cases. RESULTS: The 34 cases of gross periostitis ossificans could be classified radiographically into 4 types. Type A, showing an "onion-skin" appearance, was caused by a carious tooth or followed extraction of a tooth. Type B and type C showed a consolidation form; in the 36.8% (7/19) of these cases in which no infectious source could be identified, it was suspected that the condition was caused by a developing unerupted tooth or a dental follicle. Type D was seen in the most chronic stage. Biopsy specimens of 12 cases commonly showed proliferation of newly formed bone, loose interstitial fibrous tissue, and a low-grade inflammatory cell infiltration. CONCLUSION: Gross periostitis ossificans of type B or type C may be a specific form of mandibular osteomyelitis without demonstrable cause.

Radiographic investigation of mandibular periostitis ossificans in 55 cases.

The radiographic and clinical features of periostitis ossificans in 55 patients with mandibular osteomyelitis were studied. On the basis of whether the original mandibular contour was preserved or not, the lesions could be classified radiographically into two major types, each with two subtypes. Type I lesions were of shorter duration than Type II. Type 1-2 and Type II-1 periostitis ossificans were characteristically observed in patients under 25 years of age. Extraction of the lower third molar with pericoronitis was the most frequent cause of periostitis ossificans. An unerupted third molar tooth bud was found in close proximity to the area of periostitis ossificans in six patients. With adequate treatment there can be complete resolution of periostitis ossificans in Type I cases; however, when there has been loss of mandibular contour (Type II cases), mandibular deformity remains even when normal bony architecture has been restored.

Shin splints--a review of terminology.

This review is intended to improve the understanding of and rationale for the use of the term shin splints. Currently the term is used widely and variably, with little consensus of definition. Broadly, it denotes the occurrence of exertional lower leg pain; more specifically, it refers to an anatomical site of periostitis. The literature reports a multiplicity of descriptions and definitions of shin splints resultant from the complex etiologies and differing perceptions of these conditions. It is proposed that the term shin splint be recognized as generic, rather than diagnostic, and that specific conditions that currently exist under this term be differentiated. The etiology and interaction of these related conditions are considered, and a classification based on the current literature is given of conditions currently termed shin splints, providing a rationale for their clinical presentations, investigative findings, and interactions.

Periostitis ossificans versus Garrè's osteomyelitis. Part I. What did Garrè really say?

In 1893, C. Garrè published an article dealing with the manifestations of acute osteomyelitis. Since then, his name has been associated with diseases such as Garrè's osteomyelitis, chronic sclerosing osteomyelitis, and periostitis ossificans, among others. Scrutiny of a translated version of the original article reveals that Garrè was not responsible for the description of the disease that now bears his name.