title: Chronic nonbacterial osteomyelitis.
abstract: OBJECTIVE
  Chronic nonbacterial osteomyelitis encompasses a spectrum of sterile bony inflammatory lesions that are incompletely understood and not well known in the otolaryngology community.
  
  
  RESULTS
  Current research is investigating the underlying immunologic mechanisms postulated to be responsible for chronic nonbacterial osteomyelitis. Disruption in the innate balance between proinflammatory and anti-inflammatory cytokines is currently felt to be responsible, with several specific pathways identified as potential targets for treatment. Additionally, Propionibacterium sp. and other infectious organisms are now felt to be triggers of inflammation, rather than true causative agents.
  
  
  CONCLUSIONS
  Nonsteroidal anti-inflammatory medications remain the first-line treatment for this condition. Additional medical therapy, such as glucocorticoids, can be indicated in refractory cases. Surgical options are available for recalcitrant situations, although the potential for recurrence after surgery remains, as the underlying mechanism has not been addressed with surgery alone.
authors: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, USA.
authors: Ryan
authors: R
authors: Winters
authors: Sherard A
authors: SA
authors: Tatum
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D005938:Glucocorticoids / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000503:physiopathology; D006801:Humans; D010000:Osteitis / Q000601:surgery; D010019:Osteomyelitis / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D011425:Propionibacterium acnes / Q000302:isolation & purification
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016207:Cytokines; D005938:Glucocorticoids