Initial results of the treatment of diffuse sclerosing osteomyelitis of the mandible with bisphosphonates

ObjectiveDiffuse sclerosing osteomyelitis (DSO) of the mandible is characterised by recurrent pain, swelling of the cheek and trismus. Treatment is difficult and symptoms often recur. Recently case reports and small series have reported good results after treatment with bisphosphonates.Study designSeven patients suffering from treatment resistant DSO were treated with intravenous bisphosphonates. Diagnosis was based on clinical, radiological and histopathological examination. Symptoms had been present for between 20 and 167 months (mean 78). Patients were admitted, laboratory tests and Technetium-scans were performed. Pamidronate was administered intravenously up to four times a year. Follow-up varied from 18 to 46 months (mean 30).ResultsIn all patients, symptoms and the need for analgesic drugs diminished considerably. One patient remained free of symptoms after one treatment. In two patients a switch in bisphosphonate was made based on a decreased response. All patients showed a decrease in uptake in the DSO-area on the Tc-scans when comparing pre- and post-treatment. One patient was lost to follow-up.ConclusionIn therapy-resistant DSO bisphosphonate treatment may be a good option.