Jacobsson S
Int J Oral Surg. 1984 Oct;13(5):363-85. doi: 10.1016/s0300-9785(84)80062-9.
The medical care of patients with diffuse sclerosing osteomyelitis (DSO) of the mandible has been unsatisfactory. The main reasons for this have been insufficient knowledge of the disease and its natural history, difficulties in establishing the correct diagnosis, and the unknown etiology. The clinical features and natural history of the disease were studied by means of repeated radiographic and scintigraphic recordings. The biopsy technique was improved by using a slowly rotating coarse trepan bur. Histological and enzyme histochemical investigations were performed for determination of the histopathological diagnosis. Orthopantomograms in combination with intraoral views and 99mTc-scintigraphy were used for the radiographic diagnosis and follow-up studies. Bacteriological and serological investigations were performed in attempt to clarify the obscure etiology. The occurrence in the patients' sera of antibodies to antigens prepared from cultured bacteria was studied. ASTA, IgM, IgG, and IgA were determined and lymphocyte stimulation tests were performed. The investigations made it possible to distinguish DSO as a separate entity with rather characteristic clinical, histological and radiographic features. The histological diagnosis was facilitated by an improved biopsy technique and enzyme histochemical recordings. Different rather unspecific tissue reactions were together found to form a pattern which was strongly indicative of DSO. The radiographic and scintigraphic investigations gave valuable findings which increased the diagnostic accuracy and improved the prognostic and therapeutic judgements. The bacteriological and serological investigations indicated that propionibacterium acnes and peptostreptococcus intermedius were of etiological importance but could not explain the chronicity of the disease. The results of the different investigations gave a better understanding of DSO and made it possible to provide more appropriate care for patients in different stages of the disease. Long-term antibiotic therapy was found to have a positive influence on the course of the disease in its early stages, while cortisone therapy, and sometimes decortication, were found to be more effective in chronic stages.
下颌骨弥漫性硬化性骨髓炎（DSO）患者的医疗护理一直不尽人意。造成这种情况的主要原因是对该疾病及其自然病程了解不足、难以做出正确诊断以及病因不明。通过反复进行影像学和闪烁扫描记录来研究该疾病的临床特征和自然病程。使用缓慢旋转的粗环钻改进活检技术。进行组织学和酶组织化学研究以确定组织病理学诊断。全景曲面断层片结合口内视图和99mTc闪烁扫描用于影像学诊断和随访研究。进行细菌学和血清学调查以试图阐明不明病因。研究了患者血清中针对从培养细菌制备的抗原的抗体的出现情况。测定了ASTA、IgM、IgG和IgA，并进行了淋巴细胞刺激试验。这些研究使得能够将DSO作为一种具有相当特征性临床、组织学和影像学特征的独立疾病区分出来。改进的活检技术和酶组织化学记录有助于组织学诊断。发现不同的相当非特异性的组织反应共同形成一种强烈提示DSO的模式。影像学和闪烁扫描研究给出了有价值的结果，提高了诊断准确性并改善了预后和治疗判断。细菌学和血清学调查表明痤疮丙酸杆菌和中间型消化链球菌具有病因学重要性，但无法解释该疾病的慢性病程。不同研究的结果使人们对DSO有了更好的理解，并能够为处于疾病不同阶段的患者提供更适当的护理。发现长期抗生素治疗在疾病早期对病程有积极影响，而皮质类固醇治疗，有时还有骨皮质剥除术，在慢性阶段更有效。
