Chronic non-bacterial osteomyelitis in the jaw

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is one of the most severe form of chronic non-bacterial osteomyelitis (CNO), which could result in bone and related tissue damage. This autoinflammatory bone disorder (ABD) is very difficult for its clinical diagnosis because of no diagnostic criteria or biomarkers. CRMO in the jaw must be suspected in the differential diagnosis of chronic and recurrent bone pain in the jaw, and a bone biopsy should be considered in chronic and relapsing bone pain with swelling that is unresponsive to treatment. The early diagnosis of CRMO in the jaw will prevent unnecessary and prolonged antibiotic usage or unnecessary surgical intervention. The updated researches for the identification of genetic and molecular alterations in CNO/CRMO should be studied more for its correct pathophysiological causes and proper treatment guidelines. Although our trial consisted of reporting items from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), there are very few articles of randomized controlled trials. This article was summarized based on the author's diverse clinical experiences. This paper reviews the clinical presentation of CNO/CRMO with its own pathogenesis, epidemiology, recent research studies, and general medications. Treatment and monitoring of the jaw are essential for the clear diagnosis and management of CNO/CRMO patients in the field of dentistry and maxillofacial surgery.

Keywords: Autoinflammatory bone disorder; Chronic non-bacterial osteomyelitis; Chronic recurrent multifocal osteomyelitis; Chronic recurrent multifocal osteomyelitis in the jaw.

Fig. 1. Schematic drawing showing the autoinflammatory organ involvement of chronic recurrent multifocal osteomyelitis (CRMO).

Fig. 2. Representative computed tomographic views of chronic recurrent multifocal osteomyelitis in jaw case showing the lesion in the right mandible, axial (A), coronal (B), and sagittal (C).

Fig. 3. Schematic diagrams for the generalized medication protocols of CNO/CRMO in the jaw. (CNO: chronic non-bacterial osteomyelitis, CRMO: chronic recurrent multifocal osteomyelitis, NSAIDs: nonsteroidal anti-inflammatory drugs, TNF-α: tumor necrosis factor alpha)