Non-surgical treatment of adults with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible.

Non-surgical therapy has proved to be effective in chronic diffuse sclerosing osteomyelitis (DSO) of the mandible in children. Therefore we aimed to investigate the effect of non-surgical therapy in adult DSO patients. We included consecutive patients with DSO who received non-surgical therapy in our center. They all received occlusal splint therapy, counselling about the disease, and/or physiotherapy by a specialised team. The use of analgesics, preferably nonsteroidal anti-inflammatory drugs, was advised for symptomatic control during periods of exacerbation. Sixteen patients (11/5 female/male) aged 39.9 ± 15.0 years with DSO of the mandible were included. The mean duration of symptoms was 39.7 ± 26.3 months before referral to our center. Patients were treated with a broad range of treatments before referral. All patients underwent non-surgical treatment. In 12 patients this led to remission. Four patients still had complaints after 12 months of non-surgical therapy and started with intravenous bisphosphonate therapy. In our center, DSO of the mandible was successfully treated with non-surgical therapy, despite a long duration before referral and extensive pre-treatment. Considering this high success rate, we recommend this non-surgical approach as the first treatment option for DSO of the mandible. In case of persistence, alternative treatments such as bisphosphonates should be explored.

Conservative treatment of children with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible.

Chronic diffuse sclerosing osteomyelitis (DSO) of the mandible is a rare disease of unknown aetiology. It has been suggested that overuse of the masticatory muscles, tendoperiostitis (TP), is a contributing factor for DSO. Therefore, we tested this hypothesis by treating consecutive children with conservative therapy. All patients were treated with conservative therapy, comprising occlusal splint therapy, physiotherapy, and/or disease counselling. Pain intensity on a visual analogue scale (VAS) and pain frequency in number of days per 3 months were recorded before the start of treatment, and at 3, 6, and 12 months after treatment initiation. Eleven children (seven girls, four boys, mean age: 11.55 ± 1.97 years) were included in this study. Six patients showed a decrease in pain intensity and pain frequency over time and they continued with conservative therapy. For the remaining five patients, bisphosphonate administration was initiated because of persistent severe pain - one after 3 months of conservative therapy, and the other four after 1 year of conservative therapy. The pain complaints of patients with DSO/TP decreased with conservative therapy, and 55% did not require additional therapy. This suggests that DSO/TP of the mandible is precipitated by muscle overuse.

Periostitis ossificans (Garrè's osteomyelitis): An unusual case.

Garrè's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè's osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

Lower extremity manifestations of "skin-popping" an illicit drug use technique: A report of two cases.

UNLABELLED: Presented is a rare case of tibial and fibular osteomyelitis and a case of fibular periositis, both a direct consequence of a peculiar drug use technique. The osseous manifestations secondary to presentation of necrotic wounds with indurated rim and serous drainage with associated cellulitis, both resulting from "skin popping." Due to the complex treatment plan required, the importance of a motivated patient, a strong social support system, a controlled environment, and a multidisciplinary team cannot be overstated. Despite comprehensive efforts, devastating consequences may be unavoidable as individuals plunge downward, victimized by their addiction. LEVEL OF CLINICAL EVIDENCE: 4.

Periostitis ossificans managed with endodontic treatment.

Periostitis ossificans (PO) is a specific type of chronic osteomyelitis. Radiographically, it is characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic appearance of "onion skin." The most common cause of PO is periapical infection of the mandibular permanent first molar, which occurs primarily in children and young adults. Treatment in these cases is directed toward eliminating the source of the infection, either by extraction of the offending tooth or endodontic therapy. The purpose of this paper is to present a case of PO involving a permanent mandibular first molar managed with endodontic treatment.

Osteomielite crônica com periostite proliferativa: revisão de literatura

Devido à importância em estabelecer um correto diagnóstico radiográfico, pela dificuldade em diferenciar a osteomielite crônica com periostite proliferativa (OCPP) com outras doenças e devido à importância das imagens no controle da regressão da lesão durante o tratamento, foi realizada uma revisão de literatura dobre a OCPP, com ênfase nos aspectos de imagens (radiográfico e tomográfico). Além de abordar as características clínicas e histopatológicas. Os critérios de inclusão foram trabalhos de investigações científicas, revisões de literatura e relato de casos clínicos...

[Koletex-M absorbent paper use in acute festering odontogenic periostitis treatment].

150 patients with acute festering odontogenic periostitis were under observation. In 75 of them Koletex-M absorbent paper was used as draining material containing as active components metronidazole, dimexide and sodium alginate. In the control group of patients traditional schemes of treatment were used. Treatment process efficacy was estimated by microbiological and cytological studies. It was found that Koletex-M absorbent paper use reduced postoperative wound microbe semination. In 3 days the cells of regenerative series were found that led to speedy wound healing and reduction of temporary disability terms.

Psoriatic onychopachydermoperiostitis (POPP): a perplexing case study.

The following case of a 37-year-old male describes a very rare form of psoriasis known as psoriatic onychopachydermoperiostitis. There have been fewer than 20 cases reported worldwide.

Proliferative periostitis: a case report.

Proliferative periostitis of Garré represents a periosteal reaction to the presence of infection or other irritants. This can be odontogenic or nonodontogenic. This is a case report of an odontogenic periostitis resulting from endodontic origin. It was successfully treated by nonsurgical root canal therapy without using antibiotic therapy during the treatment of this case.

[Clinical-microbiological evaluation of the efficacy of combined use of chitosan, low intensity laser radiation and photosensitizer in treatment of patients with acute suppurative maxillofacial periostitis].

Results are presented on treatment of 68 patients with acute suppurative periostitis of maxillofacial region. After surgical interventions in patients of the study group (48 patients) the wounds were cleansed by 1% chitosan on 0.2% HC1 in combination with methylene blue and irradiated by IR laser beam. The wounds healed in 2-3 days. In the control group (20 patients) for wound dressing chlorhexidine as a standard procedure was used, length of the healing process was 5-6 days. After combined treatment the number of microflora in the wound was reduced and microflora did not show the signs of pathogenicity.

[Diagnosis and treatment of children with acute inflammatory diseases of the orbit].

The role of computer tomography within the differential diagnosis of acute inflammatory lesions of orbit tissues as well as an appropriate tactics of treatment were evaluated. Computer tomography, "Somafom AR-T", 512 x 512 pix matrix, Siemens (Germany), was made in the axial and coronary projections to delineate the inflammatory zone. The findings of computer tomography denoted explicitly the spatial features of pathology within the orbit with anatomic structures. In periostitis and reactive edema in retrobulbar fat of the orbit, the treatment of patients was conservative made jointly with otolaryngologist. Orbitotomy with drainage or with lancing of affected sinuses was made in abscess and phlegmon of the orbit. There was a complete recovery in a majority of patients with acute diseases of the orbit; they preserved their functions of the organ of vision and of its appendages. Therefore, computer tomography is a valuable and highly effective examination tool within the differential diagnosis of acute inflammatory diseases of the orbit. The diagnosis and treatment of such diseases call for a board of doctors including ophthalmologist, otolaryngologist and oral surgeon.

[Tibial periostitis ("medial tibial stress syndrome")]. / Périostite tibiale ("medial tibial stress syndrome").

Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

[Complications of rhinosinusitis]. / Vom Orbitaödem bis zum Hirnabszess. Das sind die Folgen einer vernachlässigten Sinusitis!

Rhinogenous complications may manifest in the region of the orbits, bone or soft parts of the wall of the frontal sinus, or endocranially. With regard to orbital complications, a differentiation is made between edema, periostitis, subperiosteal abscess and phlegmon--depending on severity and extent. A possible sequela of frontal sinusitis may be osteomyelitis. If the frontal bone is involved, there is a danger that the infection may spread to the endocranium via medullary spaces and blood vessels. The diagnostic basis for deciding appropriate treatment is CT or MRI. While orbital edema and periostitis usually respond to conservative treatment, subperiosteal abscess, orbital phlegmon and abscess of the brain require immediate operative treatment under antibiotic cover. The treatment of choice for osteomyelitis of the frontal bone is the liberal removal of affected bone, also under antibiotic cover.

Sclerosing osteomyelitis of Garré periostitis ossificans.

Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.

[Adsorption therapy for acute suppurative periostitis of the jaw]. / Sorbtsionnaia terapiia ostrogo gnoinogo periostita cheliusti.

Capillaries and tissue leukocyte cytograms in soft gingival tissues were examined by optic microscopy in patients with acute purulent periostitis of the jaws treated by different methods. Disorders in the lymph outflow from gingival tissues were detected, which were due to dilatation of the lymph vessels and interstitial spaces in the mucosal lamina propria and stasis with leukocyte aggregation and purulent clots in the lumina of many lymph vessels. Less pronounced dilatation of interstitial spaces and lymph vessels, higher counts of lymphocytes, monocytes, and macrophages in the tissues of the gingival mucosa lamina propria, observed 2 days after the beginning of adsorption therapy of the subperiosteal abscess cavity, indicate that this therapy is more effective in acute purulent periostitis than traditional treatment.

Proliferative periostitis of Garré: Report of a case.

Proliferative periostitis of Garré is described as a productive and proliferative inflammatory response of periosteum to infection or other irritation. This can be odontogenic or non-odontogenic in nature. This is a case report of an odontogenic periostitis resulting from periapical inflammation of endodontic origin. It was successfully treated by nonsurgical endodontics. Antibiotic therapy was not used during the treatment of this patient.

Endoscopic treatment of calcaneal spur syndrome: A comprehensive technique.

We describe a comprehensive approach to the endoscopic treatment of calcaneal spur syndrome developed by the Arthroscopic Group of the Orthopedic Service of Hospital Hermanos Ameijeiras in Havana, Cuba. The surgical technique involves treatment of the heel spur and plantar fasciitis commonly found in calcaneal spur syndrome, but it also addresses adjacent calcaneal periostitis and allows decompression of the nerve to the abductor digiti quinti. Medial endoscopy and lateral instrumentation are used in a sequential approach with exposure and debridement of the posterior roof of the calcaneal arch, followed by removal of the calcaneal spur, lateral to medial release of the medial 75% of the plantar fascia, and if necessary, debridement of the calcaneal tuberosity periosteum. This technique was used in a prospective case series from June 1997 to May 1998 to treat a select group of 38 feet in 30 patients who reported unacceptable levels of pain despite 5 months of conservative treatment, which included an aggressive 8-week physical therapy program prescribed by the treating physician. Good to excellent results were obtained at 3 months postoperatively in all patients with regard to pain relief and return to normal activity, although 5 patients required a short course of physical therapy to resolve symptoms brought on by sports, trauma, or impact loading before 1-year follow-up, at which time all patients reported good to excellent results. Complications included 3 superficial wound infections cured by oral antibiotics and 2 transient lateral paresthesias that resolved with rest and nonsteroidal inflammatory medications. The described technique may provide a useful method for treating refractory heel spur syndrome and warrants further study.

Periositite proliferativa: revisäo da literatura e ralato de caso / Prolifeative periostitis: literature review and case report

A periostite proliferativa é uma condiçäo relativamente rara que é diagnosticada comumente através de seus aspectos clínicos e radiográficos. O tratamento proposto é a remoçäo da causa e o acompanhamento radiográfico da lesäo. O objetivo deste trabalho é relatar um caso clínico e promover uma breve revisäo da literatura