Chronic Recurrent Multifocal Osteomyelitis Involving the Mandible - A Rare Case Report.

Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon, aseptic, autoinflammatory condition characterized by multifocal bone lesions with pain, swelling, and frequent exacerbations and remissions. It is noteworthy that these lesions occur without any identifiable etiology or microbiologic finding. The clavicle and metaphyses of the long bones are often involved whereas involvement of the mandible is considered rare. It is usually diagnosed by exclusion of other diseases. As it shares most of its features with the more commonly occurring infective osteomyelitis, patients are often unnecessarily subjected to prolonged courses of antibiotics, serial radiation exposures, and repeated bone biopsies. We present a case of CRMO involving the mandible. Our primary objective is to demonstrate the clinical features of this uncommon disorder, highlighting the radiographic appearance. Familiarity with this condition among radiologists greatly increases the likelihood for early diagnosis and formulating an appropriate treatment plan.

Squamous Odontogenic Tumor: Review of the Literature and Report of a New Case.

PURPOSE: Squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative odontogenic tumor of the gnathic bones. It is composed of islands of bland, well-differentiated squamous epithelium of varying shape and size. Because of histologic overlap, SOT has often been overdiagnosed as ameloblastoma and squamous cell carcinoma. It thus becomes important to understand the clinical, radiologic, histopathologic, and treatment characteristics of this tumor. MATERIALS AND METHODS: Using the PubMed and Google Scholar databases, we searched for reported cases of SOT published in the English-language literature. We were able to retrieve 49 acceptable cases and perform a comprehensive literature review of the intraosseous SOTs, with emphasis on their clinical, radiographic, and pathologic characteristics, as well as treatment strategies. In addition, we present an additional case of SOT affecting the posterior mandible in a 44-year-old female patient. RESULTS: The tumor in the posterior mandible in our patient was accompanied by acute pain and treated by enucleation. Histopathologic evaluation showed variably sized islands of benign squamous epithelium scattered in a fibrous stroma, consistent with the diagnosis of an SOT. Uneventful healing was noted at the 1-month postoperative appointment. However, the patient was lost to long-term follow-up. Our literature review showed that the average age at the time of diagnosis of SOT is 34.2 years. Men and women are equally affected, and the tumor does not show a predilection for either jaw bone. The most common locations are the anterior maxilla and posterior mandible. Most SOTs are treated conservatively by enucleation or curettage, whereas aggressive or recurrent tumors require radical resection. CONCLUSIONS: Careful evaluation of the excised specimen, with immunohistochemical investigations, may prove rewarding in differentiating an SOT from other odontogenic neoplasms and thus minimize the patient's chances of undergoing an unnecessary aggressive intervention.

Incidental findings of posterior arch defects of the atlas in orthodontic patients: A case series.

INTRODUCTION: Congenital defects of the posterior arch of atlas are uncommon anomalies that may go unnoticed. Radiographs and cone-beam computed tomography scans made for orthodontic purposes often show the atlas; therefore, these rare defects might first be noted as incidental findings on orthodontic records. METHODS: A series of 7 cases of posterior arch defects of atlas (C1) that were detected during routine radiographic examination are presented here. RESULTS: The distribution of the defects was as follows: type A, 2; type B, 1; type C, none; type D, 1; and type E, 3. CONCLUSION: As the potential complications associated with these defects may be quite concerning, a thorough analysis of the radiographs for these defects is imperative.

Gorham-Stout disease of the mandible: case report and review of literature of a rare type of osteolysis.

Gorham-Stout disease (GSD) is a rare form of osteolysis, the aetiology and pathogenesis of which remains controversial to this date. Although more than 200 cases of GSD have been reported so far, this disease continues to go undiagnosed in the initial stages owing to its varied clinical presentations and rarity. Through this case report of GSD in a 3-year-old boy, we discuss the slow progression of the disease over a period of 13 years. The literature review is also done with an emphasis on the role of an oral and maxillofacial radiologist in understanding the disease at its incipient stage.

Condylar jugular diverticulum: A report of 3 cases.

Jugular bulb diverticulum is an irregular extension of the jugular bulb into the temporal bone that may be symptomatic or asymptomatic. The jugular bulb has rarely been reported to extend into the occipital condyle; such extension is termed a condylar jugular diverticulum and is characterized as a defect in the occipital condyle contiguous with the jugular bulb. This report details 3 cases of condylar jugular diverticulum. Extension of the jugular bulb into the ipsilateral occipital condyle was noted as an incidental finding on cone-beam computed tomographic (CBCT) images of 3 patients. All 3 patients were asymptomatic, and this finding was unrelated to the initial area of interest. CBCT use is becoming ubiquitous in dentistry, as it allows 3-dimensional evaluation, unlike conventional radiography. Proper interpretation of the entire CBCT is essential, and recognition of the indicators of condylar jugular diverticulum may prevent misdiagnosis of this rare entity.

Trichodentoosseous syndrome: a case report and review of literature.

Trichodentoosseous (TDO) syndrome is a rare autosomal dominant condition characterized by various dental and non-dental findings such as taurodontism, amelogenesis imperfecta, osseous dysplasia, mandibular prognathism, curly hair, dysplastic nails, which may be symptomatic or asymptomatic. TDO syndrome is divided into three subtypes that helps to categorize different features seen in patients. There are very few cases reported in the literature of TDO syndrome. We present a case of a young adult male showing interesting Type I and II clinical and radiographic findings of the TDO syndrome. Amelogenesis imperfecta hypomaturation-hypoplastic type and TDO syndrome overlaps in their dental findings such as taurodontism and enamel hypoplasia and makes the diagnosis of TDO crucial. TDO syndrome was noted as an incidental finding on cone beam CT. This case report highlights the pathognomonic radiographic findings, treatment plan, and the clues to diagnosis this rare disorder. Management of TDO requires a proper diagnosis, multidisciplinary approach with comprehensive treatment plan including periodic follow up. Knowledge of this condition along with thorough interpretation of the entire cone beam CT volume are critical to understand this syndrome better due to its rarity.

Radiographic bone loss and the risk of medication-related osteonecrosis of the jaw (MRONJ) in multiple myeloma patients-A retrospective case control study.

Risk factors for medication-related osteonecrosis of the jaws (MRONJ) include type and duration of antiresorptive drugs, dental trauma, local anatomy, systemic underlying conditions and therapy, smoking, and the presence of periodontal disease. However, there is a lack of studies elucidating the role of periodontal disease as risk predictor. In the present study, the dental charts of 100 multiple myeloma (MM) patients and 16 MM patients who developed MRONJ were studied. Information about age, gender, smoking history, diabetes, steroid drug intake, type and duration of bisphosphonate (BP) treatments, MRONJ status, missing teeth, periapical lesions, widening of the periodontal ligament, and periodontal status was collected. The periodontal status was determined as a percentage of missing bone at the mesial and distal surfaces of each tooth. Multivariable logistic regression was performed to identify risk factors associated with MRONJ. In the selected model, using the COX analysis, categorical bone loss percentage is significantly associated with MRONJ (P = 0.009), with hazard ratio 0.042 (high vs low) and 95% CI 0.004 to 0.453. Gender, steroid, Aredia BP type, and periapical are also significant in selected model. In conclusion, advanced alveolar bone loss and missing teeth were strongly related to the occurrence of MRONJ in MM patients.

Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome.

BACKGROUND: Radiculomegaly, or root gigantism, is a rare dental abnormality with important clinical implications. It is highly specific for oculo-facio-cardio-dental (OFCD) syndrome, which places dentists at the forefront of diagnosis of this syndrome. Only 1 case of nonsyndromic radiculomegaly has been reported in the literature since the description of OFCD syndrome in 1996. We present the second confirmed, nonsyndromic/nonfamilial case and review the literature for dental treatments in patients with this dental finding. STUDY DESIGN: A review of the English language literature was performed in PubMed for patients with radiculomegaly or OFCD syndrome. Teeth affected by radiculomegaly, gender, orodental findings, presence of OFCD syndrome, and dental treatment methods were recorded. RESULTS: Sixty-seven cases of radiculomegaly and 92 cases of OFCD syndrome were found in the literature. Only 1 confirmed case of nonsyndromic/nonfamilial radiculomegaly had been reported previously. Ten reports described dental treatment or treatment plan details, and even fewer included specific methods. CONCLUSIONS: Because dental anomalies, especially radiculomegaly, are a primary feature of OFCD syndrome, dentists should be aware of the clinical and radiographic features. Radiculomegaly poses a distinct challenge to dentists, and reports of dental therapy provided to these patients are sparse. Early diagnosis of the syndrome may prevent dental challenges and improve prognosis.

Radiographic features of plasma cell leukemia in the maxilla: A case report.

Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.

Simultaneous gingival squamous cell carcinoma in an oral lichen planus patient.

OBJECTIVE: To describe a case of bilateral simultaneous squamous cell carcinoma of the gingiva affecting the mandible in a lichen planus patient and discuss the pertinent literature. METHOD AND MATERIALS: We present a case of a 50-year-old woman with a history of oral lichen planus who was diagnosed with a primary and a second primary squamous cell carcinoma originating from the mandibular gingiva. A literature review did not disclose cases of gingival carcinoma arising simultaneously and bilaterally in the mandible. RESULTS: Presentation of two simultaneous clinically distinct squamous cell carcinoma of gingiva, invading underlying mandible, is rare. Second primary tumor refers to a concomitant malignancy that is independent from the primary tumor. Second primary tumor is an independent prognostic factor since the surgical procedure is highly influenced by the extent of bony invasion. CONCLUSION: The general practitioner should be aware of the possibility of multiple independent lesions at different sites of the oral cavity. A thorough oral examination of sites remote from the obvious main lesion should be performed. The presence of simultaneous primary oral cancerous lesions may indicate a greater morbidity and a grave outcome for the patient.

Radiographic manifestations of Mönckeberg arteriosclerosis in the head and neck region.

Mönckeberg sclerosis is a disease of unknown etiology, characterized by dystrophic calcification within the arterial tunica media of the lower extremities leading to reduced arterial compliance. Medial calcinosis does not obstruct the lumina of the arteries, and therefore does not lead to symptoms or signs of limb or organ ischemia. Mönckeberg sclerosis most commonly occurs in aged and diabetic individuals and in patients on dialysis. Mönckeberg arteriosclerosis is frequently observed in the visceral arteries, and it can occur in the head and neck region as well. This report describes a remarkable case of Mönckeberg arteriosclerosis in the head and neck region as detected on dental imaging studies. To the best of our knowledge, this is the first case that has been reported in which this condition presented in the facial vasculature. The aim of this report was to define the radiographic characteristics of Mönckeberg arteriosclerosis in an effort to assist health care providers in diagnosing and managing this condition.