Clinical, Radiographic, and Histopathological Characterization of Osteomyelitis of the Jaws: A 51-Year Experience at an Oral Pathology Service

Introduction: Osteomyelitis is an inflammatory condition of the bone with a multifactorial etiology, including trauma and odontogenic infections. Despite being a common condition in clinical practice, limited research exists on the clinical and pathological profile of Osteomyelitis of the Jaws (OJ). This 51-year retrospective study aimed to describe the clinical, radiographic, and histopathological features of OJ diagnosed at a single oral pathology referral center.

Material and methods: Clinical, radiographic, and histopathological data of cases diagnosed as OJ were collected and categorized using Zurich Classification System.

Results: Among 17,991 cases diagnosed at the service, 75 (0.004%) were identified as OJ. Patients were predominantly female (n = 67; 89.3%), with a mean age of 42.68 years (±21.10) at diagnosis. OJ commonly presented as slow-growing, symptomatic lesions (n = 69; 92.0%) with a predilection for the mandible. Secondary chronic osteomyelitis (SCO) was the most common subtype (n = 44; 84.0%). Odontogenic infections were identified as the most common etiological factor associated with OJ (n = 41; 54.7%). Radiographic analysis frequently revealed generalized, moderate bone loss, while histopathological examination often showed a discrete mononuclear inflammatory infiltrate (n = 29; 38.7%). Bacterial colonies were observed in 26 cases (34.7%) and were significantly associated with SCO (p = 0.04).

Conclusion: The findings indicate that OJ is a rare condition in oral pathology centers, predominantly affecting white females in their fifth decade at life, with a predilection for the mandible. Dental infections were the primary causative factor. SCO is the most common OJ subtype in cases requiring surgical management.