Diagnosis and management strategies of infectious and chronic diffuse sclerosing osteomyelitis: a retrospective study.

IF 2 3区 医学 Q2 Dentistry
Océane Meriaux, Pauline Preuss, Sophie Dugast, Helios Bertin, Pierre Corre, Benoit Le Goff
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引用次数: 0

Abstract

Introduction: Chronic diffuse sclerosing osteomyelitis (CDSO) is a rare, non-suppurative mandibular condition that often mimics infectious osteomyelitis (IO), making diagnosis and management challenging. This study aimed to identify key clinical, radiological, histopathological, and therapeutic features distinguishing CDSO from IO and to propose a diagnostic and treatment strategy.

Materials and methods: We conducted a retrospective descriptive study of 43 patients treated for mandibular osteomyelitis at Nantes University Hospital between 2007 and 2020. Clinical records, imaging, histological and microbiological data, and treatment outcomes were analyzed and compared between patients diagnosed with CDSO and those with IO.

Results: CDSO affected mainly middle-aged women and showed a high recurrence rate despite prolonged antibiotic use. It was characterized by mononuclear infiltrates, medullary fibrosis, and bone condensation without abscess formation. In contrast, IO showed neutrophilic infiltrates, bacterial clusters, and osteolysis often with soft tissue abscesses. Antibiotics were effective in IO but frequently failed in CDSO. Anti-inflammatory and rheumatologic treatments, including NSAIDs, corticosteroids, bisphosphonates, and biotherapies, showed variable but encouraging responses in CDSO. Imaging differences, particularly on CBCT and CT, helped differentiate the two entities.

Discussion: This study highlights the need for a multidisciplinary approach, including rheumatologic expertise, in the management of CDSO. The lack of gold standard diagnostic criteria complicates classification, yet histopathology and radiology provide helpful orientation. Larger prospective studies are warranted to validate our findings and optimize treatment protocols for CDSO.

传染性和慢性弥漫性硬化性骨髓炎的诊断和治疗策略:一项回顾性研究。
慢性弥漫性硬化性骨髓炎(CDSO)是一种罕见的非化脓性下颌疾病,通常类似感染性骨髓炎(IO),使诊断和治疗具有挑战性。本研究旨在确定CDSO与IO的关键临床、放射学、组织病理学和治疗特征,并提出诊断和治疗策略。材料和方法:我们对2007年至2020年在南特大学医院治疗的43例下颌骨髓炎患者进行了回顾性描述性研究。对诊断为CDSO的患者和诊断为IO的患者的临床记录、影像学、组织学和微生物学数据以及治疗结果进行分析和比较。结果:CDSO以中年妇女为主,尽管长期使用抗生素,但复发率较高。其特征为单核浸润、髓质纤维化和骨凝聚,无脓肿形成。相比之下,IO表现为中性粒细胞浸润、细菌团簇和骨质溶解,常伴有软组织脓肿。抗生素对IO有效,但对CDSO往往无效。抗炎和风湿病治疗,包括非甾体抗炎药、皮质类固醇、双膦酸盐和生物疗法,在CDSO中显示出不同但令人鼓舞的反应。影像上的差异,特别是CBCT和CT上的差异,有助于区分两种实体。讨论:这项研究强调了在CDSO的管理中需要多学科方法,包括风湿病学专业知识。缺乏金标准诊断标准使分类复杂化,但组织病理学和放射学提供了有用的方向。需要更大规模的前瞻性研究来验证我们的发现并优化CDSO的治疗方案。
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来源期刊
CiteScore
2.20
自引率
9.10%
发文量
305
期刊介绍: J Stomatol Oral Maxillofac Surg publishes research papers and techniques - (guest) editorials, original articles, reviews, technical notes, case reports, images, letters to the editor, guidelines - dedicated to enhancing surgical expertise in all fields relevant to oral and maxillofacial surgery: from plastic and reconstructive surgery of the face, oral surgery and medicine, … to dentofacial and maxillofacial orthopedics. Original articles include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses. All manuscripts submitted to the journal are subjected to peer review by international experts, and must: Be written in excellent English, clear and easy to understand, precise and concise; Bring new, interesting, valid information - and improve clinical care or guide future research; Be solely the work of the author(s) stated; Not have been previously published elsewhere and not be under consideration by another journal; Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey Platforms.
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