title: Juvenile Mandibular Chronic Osteomyelitis: Role of Surgical Debridement and Antibiotics.
abstract: OBJECTIVE
  To document outcomes of management of juvenile mandibular chronic osteomyelitis (JMCO) using a standardized treatment protocol including open biopsy, decortication, microbial culture, and long-term antibiotic therapy.
  
  
  METHODS
  This was a retrospective case study of pediatric patients with JMCO treated at Massachusetts General Hospital for Children from 1996 through 2014. Inclusion criteria included age younger than 18 years, diagnosis of JMCO, management by the protocol, adequate clinical and radiographic data in the record, and follow-up of at least 1 year after initial treatment. Inpatient and outpatient records were reviewed for demographics, clinical and radiographic findings, and histologic and laboratory evaluations. The predictor variable was the standardized treatment protocol and the primary outcome variables were disease status at end of treatment and complications of treatment.
  
  
  RESULTS
  Twenty patients (mean age at onset, 10.7 yr; range, 3 to 14 yr) were treated, 12 (11 girls) of whom met the inclusion criteria. Management of all patients consisted of biopsy (extraoral when feasible, n = 9; intraoral, n = 3), decortication, cultures, and long-term antibiotic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered only as needed for pain control. There was complete resolution of osteomyelitis with no recurrence in 7 of 12 patients (mean follow-up, 4.3 yr; range, 1 to 11 yr). Five patients had partial responses, with decreased frequency and severity of disease recurrence. These were well controlled with short courses of antibiotics (4 to 12 weeks) with NSAIDs only as needed for pain control (mean follow-up, 1.4 yr; range, 1 to 3 yr). There were no major complications related to antibiotic therapy. Minor complications included rash (n = 2), nausea and vomiting (n = 1), and vaginal candidiasis (n = 1).
  
  
  CONCLUSIONS
  The results of this study indicate that 58.3% of patients were cured and had no recurrent symptoms (mean follow-up, 4.3 yr). The remaining patients continue on intermittent treatment with antibiotics for recurrent episodes of swelling and pain. Favorable responses to antibiotic therapy support the hypothesis that JMCO is an infectious disease and that negative cultures might represent a failure of standard culture techniques to isolate the responsible organisms.
authors.affiliation: Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Shravan
authors.initials: S
authors.lastname: Renapurkar
authors.affiliation: Associate Professor and Unit Chief, Pediatric Infectious Disease, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Pasternack
authors.affiliation: Associate Professor, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: G Petur
authors.initials: GP
authors.lastname: Nielsen
authors.affiliation: Walter C. Guralnick Distinguished Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Massachusetts General Hospital for Children, Harvard School of Dental Medicine, Boston, MA. Electronic address: Kaban.leonard@mgh.harvard.edu.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D010147:Pain Measurement; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents