J Korean Assoc Oral Maxillofac Surg.  2016 Aug;42(4):215-220. 10.5125/jkaoms.2016.42.4.215.

Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases

• Park J
• Myoung H

• KMID: 2350074
• DOI: http://doi.org/10.5125/jkaoms.2016.42.4.215

Abstract

In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.

Keyword

Osteomyelitis; Juvenile periodontitis; Periostitis; Folliculitis

MeSH Terms

Aggressive Periodontitis
Anti-Bacterial Agents
Child
Debridement
Dental Caries
Folliculitis
Follow-Up Studies
Humans
Inflammation
Molar, Third*
Osteogenesis
Osteomyelitis*
Periodontitis
Periostitis*
Young Adult
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Clinical photos. A. Swelling of the right mandible. B. Lateral view. C. Intraoral photo showing pericoronitis of the lower second molar.

• 

  Fig. 2 Panoramic view shows follicular space widening of the right lower third molar.

• 

  Fig. 3 New periosteal bone formation in the right angle of the mandible (arrow).

• 

  Fig. 4 Computed tomography image reveals cortical perforation around the right third molar follicle and pus formation.

• 

  Fig. 5 Surgical intervention. A. Initial presentation of the cutaneous sinus and pus discharge. B. Extraction of the tooth germ. C. Intraoral lesions after surgical debridement.

• 

  Fig. 6 Clinical photos. A. Swelling of the right mandible. B. Oblique view. C. Erupting second molar covered with operculum. A drain was introduced.

• 

  Fig. 7 Loss of follicular cortex around the right mandibular third molar.

• 

  Fig. 8 Focal abscess formation with increasing bone marrow attenuation (arrow).

• 

  Fig. 9 Surgical intervention. A. Extracted tooth germ and follicle. B. Surgical debridement of extraction socket.

• 

  Fig. 10 Clinical photo taken on postoperative day 17. A. Swelling of the right mandible was resolved. B. Oblique view. C. Postoperative wound healing was done.

Reference

1. Hudson JW. Osteomyelitis of the jaws: a 50-year perspective. J Oral Maxillofac Surg. 1993; 51:1294–1301. PMID: 8229407.

2. Reck SF, Fielding AF, Hess DS. Osteomyelitis of the coronoid process secondary to chronic mandibular third molar pericoronitis. J Oral Maxillofac Surg. 1991; 49:89–90. PMID: 1985188.

3. Mohammed-Ali RI, Collyer J, Garg M. Osteomyelitis of the mandible secondary to pericoronitis of an impacted third molar. Dent Update. 2010; 37:106–108. PMID: 20415010.

4. Lambade P, Lambade D, Dolas RS, Virani N. Ectopic mandibular third molar leading to osteomyelitis of condyle: a case report with literature review. Oral Maxillofac Surg. 2013; 17:127–130. PMID: 22847038.

5. Wang R, Cai Y, Zhao YF, Zhao JH. Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review. Aust Dent J. 2014; 59:372–374. PMID: 24819410.

6. Tong AC, Ng IO, Yeung KM. Osteomyelitis with proliferative periostitis: an unusual case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:e14–e19. PMID: 17052617.

7. Benca PG, Mostofi R, Kuo PC. Proliferative periostitis (Garré's osteomyelitis). Oral Surg Oral Med Oral Pathol. 1987; 63:258–260. PMID: 3469611.

8. Eyrich GK, Baltensperger MM, Bruder E, Graetz KW. Primary chronic osteomyelitis in childhood and adolescence: a retrospective analysis of 11 cases and review of the literature. J Oral Maxillofac Surg. 2003; 61:561–573. PMID: 12730835.

9. Heggie AA, Shand JM, Aldred MJ, Talacko AA. Juvenile mandibular chronic osteomyelitis: a distinct clinical entity. Int J Oral Maxillofac Surg. 2003; 32:459–468. PMID: 14759102.

10. van Merkesteyn JP, Groot RH, van den Akker HP, Bakker DJ, Borgmeijer-Hoelen AM. Treatment of chronic suppurative osteomyelitis of the mandible. Int J Oral Maxillofac Surg. 1997; 26:450–454. PMID: 9418149.