Chronic recurrent osteomyelitis: A surgeon's enigma.
BACKGROUND
Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis.


METHODS
A thorough workup which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti-inflammatory with or without surgical debridement/adjuvant therapies. Correlation of our findings and treatment plan was done with evidence-based literature and practice.


RESULTS
Complete resolution of symptoms with radiographic evidence was achieved in both the cases. In the recurrence period, long-term steroids, NSAIDs, antibiotics resulted in better outcomes.


CONCLUSION
The evidence-based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom-free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.
['Kudva|Adarsh|A|http://orcid.org/0000-0002-1559-5938', 'Kamath|Abhay T|AT|', 'Dhara|Vasantha|V|', 'Ravindranath|Vineetha|V|']
D000328:Adult D000900:Anti-Bacterial Agents D000894:Anti-Inflammatory Agents, Non-Steroidal D002648:Child D002908:Chronic Disease D003646:Debridement D019317:Evidence-Based Medicine D005938:Glucocorticoids D006801:Humans D021621:Imaging, Three-Dimensional D008279:Magnetic Resonance Imaging D008334:Mandible D019647:Oral Surgical Procedures D000066794:Oral and Maxillofacial Surgeons D010019:Osteomyelitis D012008:Recurrence D014057:Tomography, X-Ray Computed
steroids chronic recurrent multifocal osteomyelitis computed tomography non-steroidal anti-inflammatory drugs sclerosing osteomyelitis