Presentation
Jaw pain.
Patient Data
Large bilateral mandibular tori. Bone loss at the posterior aspect left mandibular torus (lingual to 37, absent 38) with asymmetric medullary sclerosis.
Absent 11 with focal alveolar recession. 14 periapical lucency. 45 idiopathic osteosclerosis.
HISTOPATHOLOGY
MACROSCOPIC: Left mandible site 36: A fragment of roughened bone 9 x 5 x 3 mm. Decalcified prior to processing
MICROSCOPIC: The sections show a trabecular bone which is viable. It has fairly regular cement lines, but some areas of the bony trabeculae are irregular, and focal areas of osteoblastic rimming are noted. No osteonecrosis or inflammatory exudate seen. The marrow spaces mildly fibrotic, containing mild chronic inflammatory cell infiltrate of lymphocytes and plasma cells. No active or suppurative inflammation seen. No granulomas identified. There is no neoplasm.
DIAGNOSIS:
Left mandible site 36: Although there is no osteonecrosis, there is low–grade chronic inflammation and focal bony remodeling which is suggestive of chronic osteomyelitis. Please correlate with clinical and imaging findings.
Case Discussion
The imaging and histopathological findings confirmed the clinical suspicion of chronic osteomyelitis.
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