Abukhder Munir, Nasri Elmi Salmane, Van Der Lith Sarah, Hawesa Nour, Abukhder Daniah, Abid Husnain, Liu Linda
Northwick Park Hospita, Harrow HA1 3UJ.
King's College London, Strand, London, WC2R 2LS.
Ann Med Surg (Lond). 2023 Dec 13;86(2):950-957. doi: 10.1097/MS9.0000000000001561. eCollection 2024 Feb.
Diffuse sclerosing osteomyelitis (DSO) affecting the mandible is an uncommon condition characterised by recurrent pain and functional disturbances. Traditional treatments involving antibiotics, steroids, and analgesics have generally yielded unsatisfactory results. Numerous articles have proposed the utilisation of bisphosphonate therapy as an alternative approach to achieve sustained symptom relief. This study aims to consolidate the available evidence on the effectiveness of bisphosphonate therapy in managing DSO.
A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies were devised, and studies were screened based on predefined inclusion and exclusion criteria.
Ten articles met the eligibility criteria, encompassing a total of 135 patients diagnosed with DSO who received bisphosphonate treatment. All included studies consistently reported a reduction in pain levels and swelling, along with a decrease in the cumulative use of analgesics. The majority of patients reported long-lasting symptom improvement with bisphosphonate therapy. Notably, four studies documented improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Furthermore, six studies observed improvements in panoramic radiographs and cone beam computed tomography scans, with one publication describing two patients exhibiting near-normal bone architecture. Importantly, all studies reported the absence of long-term complications.
Bisphosphonate therapy emerges as a promising treatment modality for DSO, exhibiting efficacy in symptom alleviation and radiological enhancement while conferring lasting benefits. Nevertheless, further prospective studies are warranted to refine treatment protocols and substantiate these findings.
累及下颌骨的弥漫性硬化性骨髓炎（DSO）是一种罕见疾病，其特征为反复疼痛和功能障碍。涉及抗生素、类固醇和镇痛药的传统治疗通常效果不佳。众多文章提出使用双膦酸盐疗法作为实现持续症状缓解的替代方法。本研究旨在汇总关于双膦酸盐疗法治疗DSO有效性的现有证据。
一项系统评价方案已在国际前瞻性系统评价注册库（PROSPERO）登记，并按照系统评价和Meta分析的首选报告项目进行报告。制定了全面的电子检索策略，并根据预先定义的纳入和排除标准对研究进行筛选。
10篇文章符合纳入标准，共纳入135例诊断为DSO并接受双膦酸盐治疗的患者。所有纳入研究均一致报告疼痛程度和肿胀减轻，以及镇痛药累计使用量减少。大多数患者报告双膦酸盐疗法使症状得到长期改善。值得注意的是，4项研究记录了最大开口度的改善，其中1项研究报告平均增加了9.6毫米。此外，6项研究观察到全景X线片和锥形束计算机断层扫描有改善，1篇文献描述2例患者骨结构接近正常。重要的是，所有研究均报告无长期并发症。
双膦酸盐疗法成为治疗DSO的一种有前景的治疗方式，在缓解症状和影像学改善方面显示出疗效，并带来持久益处。然而，仍需要进一步的前瞻性研究来完善治疗方案并证实这些发现。
