Focal osteomyelitis with proliferative periostitis

A 22-year-old female presented to our clinic with the main complaint of pain and swelling in the left mandible. The medical history revealed no co-morbidities. Extraoral examination revealed a draining sinus and a hard, firm swelling in the posterior left mandible. Intraoral examination revealed multiple carious teeth and healthy overlying mucosa. A panoramic radiograph was performed (Figure 1). Radiographic examination revealed a missing 18, impacted 28, 38, 48 and carious lesions on the 17, 15, 37 and 36. A periapical radiolucency is associated with the grossly carious 37 and in addition a convex radiopacity and onion skin-like periosteal reaction is noted, whereby numerous layers of new cortical bone is deposited in relation to the 37. The radiopacity extent includes the 37 area, with the affected bone appearing more sclerotic and dense. The adjacent cortical bone is normal. The periosteal reaction resulted in expansion of the cortical border, whilst remaining intact. There is a clear demarcation of the original cortical border and the new bone deposition (Figure 2). As the clinical and radiographic features were consistent with that of focal osteomyelitis with proliferative periostitis, a definitive diagnosis was made without the need for histological investigations. Subsequently, the grossly carious 37 was extracted and antibiotics was prescribed. The patient responded well to the treatment and treatment of the other carious lesions has commenced.