Chronic fibrosing osteomyelitis of the jaws: An important cause of recalcitrant facial pain. A clinicopathologic study of 331 cases in 227 patients

Publication date: Available online 8 June 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Lawrence I. Goldblatt, William R. Adams, Kenneth J. Spolnik, Kevin A. Deardorf, Edwin T. Parks
ObjectiveA retrospective and followup analysis of 331 cases of Chronic Fibrosing Osteomyelitis of the Jaws (CFOJ) in 227 patients.Study DesignDemographic, clinical, surgical and microscopic characteristics were tabulated for all patients. A followup mail survey was used to determine degree of symptom relief experienced since surgery.ResultsThe female/male ratio approached 7/1 with a mean age of 53 years. The most common sites were the mandibular posterior followed by the maxillary posterior regions. Consistent clinical findings included intractable jaw pain mimicking odontogenic origin but unresponsive to usual therapies, minimal or undetectable radiographic abnormalities on plain films but dramatic radiolucencies detected on Cone Beam Computerized Tomography, and large cavities either empty or filled with blood mixed with lipid globules encountered at surgery. The most common histomorphologic findings were vital lamellar bone, prominent resting and reversal lines, microshards and splaying of trabeculae, rounded trabeculae, marrow fibrosis and pools of erythrocytes and lipid globules, often together. Moderate to complete relief of symptoms for periods up to 108 months post-surgery were reported by 83% of the 70 patients who returned the survey.ConclusionsBased upon this study, CFOJ is a unique entity with consistent clinicopathologic features. Its features suggest a pathogenesis based on bone marrow ischemia. CFOJ can be treated on a rational basis with a justifiable expectation of success and probably cure.



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