Cone beam computed tomographic findings in refractory chronic suppurative osteomyelitis of the mandible

Abstract

Aims: To report the imaging features of osteomyelitis of the mandible in various two-dimensional multiplanar and three-dimensional reformations using cone beam computed tomography (CBCT).

Methods: The images were 12-bit DICOM files acquired with a 10cm field of view and voxel resolution of 0.4mm. Two-dimensional multiplanar reformatted reconstructions included coronal, "panoramic" (variable thickness), and serial cross-sections. Three-dimensional reconstructions included surface renderings. Images were presented to referring oral and maxillofacial surgeons in "real time" immediately after acquisition.

Results: The features of mandibular osteomyelitis seen on CBCT included: a peripheral sclerotic rim, cortical layering (involucrum), central loss of trabecular pattern with internal round radiolucent resorptive tracts, minimal jaw expansion, and reduction of the alveolar cortex. Sequestra were occasionally evident. The history and presentation of each case on CBCT were consistent with osteomyelitis of the mandible; however, the clinical differential diagnosis in each case had included malignancy. The definitive diagnosis was confirmed by histological examination of biopsy specimens. Two of the three cases were patients who had been treated with bisphosphonates.

Conclusion: CBCT facilitated comprehensive and dynamic imaging of the jaws based on surgical consultation, rather than inflexible imaging protocols. CBCT images guided operative planning.