Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Oral Radiol. 2021 Jan;37(1):137-145. doi: 10.1007/s11282-020-00462-x. Epub 2020 Jun 30.
Actinomycotic osteomyelitis is an aggressive and persistent disease capable of invading and destroying bone, and chronic osteomyelitis with proliferative periostitis represents new bone formation with periosteal reaction. We report a rare case of actinomycotic osteomyelitis with proliferative periostitis arising in the mandibular ramus and spontaneous bone regeneration after coronoidectomy. A 14-year-old girl was referred for swelling in the right parotid-masseteric region and severe trismus. Contrast-enhanced CT revealed that heterogenous enhancement of the right masseter muscle, and a reactive bone formation over the lateral cortex of the right mandibular ramus and osteolysis of the condyle were seen in plain CT. MRI showed that the mandibular ramus was a low-signal intensity and the reactive bone on the ramus was signal intensity similar to muscle on T1-weighted images. The lesion was clinically and radiologically diagnosed as chronic osteomyelitis of the mandibular ramus. However, a biopsy was performed intraorally under general anesthesia to rule out a malignant bone tumor, and pathological examination showed fibrous bone and Actinomyces druses. Finally, the lesion was diagnosed as actinomycotic osteomyelitis with proliferative periostitis. She underwent image-guided intraoral removal of impacted right third molar and reactive proliferative bone on the right mandibular ramus under general anesthesia. To improve trismus, coronoidectomy also was performed. After the discharge, AMPC was administrated intraorally for 7.5 months. Postoperative panoramic radiograph and CT showed the right mandibular angle resorption and coronoid process regeneration. There was no recurrence of mandibular osteomyelitis 7 years after surgery.
放线菌性骨髓炎是一种侵袭性和持续性疾病，能够侵犯和破坏骨骼，而伴有骨膜反应的慢性骨髓炎则代表着新骨形成。我们报告了一例罕见的放线菌性骨髓炎伴骨膜反应，发生在下颌支，并在髁突切除术自发骨再生。一名 14 岁女孩因右侧腮腺-咬肌区肿胀和严重牙关紧闭而就诊。增强 CT 显示右侧咬肌不均匀强化，右侧下颌支外侧皮质有反应性骨形成，髁突有溶骨性破坏。MRI 显示下颌支呈低信号强度，支上的反应性骨在 T1 加权图像上与肌肉信号强度相似。病变临床和影像学诊断为慢性下颌骨骨髓炎。然而，为了排除恶性骨肿瘤，在全身麻醉下进行了口腔内活检，病理检查显示纤维骨和放线菌结。最后，病变诊断为放线菌性骨髓炎伴骨膜反应。她在全身麻醉下接受了影像学引导的右侧下颌第三磨牙和右侧下颌支反应性增生骨的口腔内切除。为了改善牙关紧闭，还进行了髁突切除术。出院后，口服 AMPC 治疗 7.5 个月。术后全景片和 CT 显示右侧下颌角吸收和喙突再生。术后 7 年无下颌骨髓炎复发。
