A patient gives a history of symptoms continuing over several weeks and reports episodes of pain and swelling in the jaw. On palpation, lymphadenopathy is observed. On clinical examination, evidence of sinus formation is also seen. The radiograph of the patient is shown below. What will be the diagnosis?
Chronic suppurative (or rarefying) osteomyelitis:
The disease can occur de novo or represent a progression from the acute stage into a chronic form.
Radiological signs
The periphery of the lesion may be irregular and ill-defined or, in more established cases, a peripheral sclerosis may be seen separating normal from infected bone. Adjacent teeth, if involved in the inflammatory process, will show loss of the lamina dura. The involved bone shows ill-defined patchy radiolucency separated by loci of apparently “normal” bone. As the disease progresses, these radiolucent areas will coalesce and enlarge, often involving the cortex of the bone. The dense radiopacities are islands of non-vital necrotic bone or sequestra. The disease can induce new bone formation, a process referred to as proliferative periostitis or involucrum formation This is seen as one or more radiopaque lines parallel to the cortex and to each other.
Key Concept
Chronic suppurative (or rarefying) osteomyelitis
Acute osteomyelitis
Garre's osteomyelitis
Sclerosing osteomyelitis