A case of diffuse sclerosing osteomyelitis of the mandible in a juvenile patient that was treated successfully with pamidronate

Diffuse sclerosing osteomyelitis (DSO) of the mandible is known to be treatment-refractory osteomyelitis. DSO usually cannot be successfully treated by antibiotics, and there are no established treatments. We describe a case of DSO of the mandible in a juvenile patient that was successfully treated by intravenous pamidronate. The patient was a 14-year-old girl who was referred to our department in April 2008 because of left mandibular pain and swelling. Computerized tomography showed cortical bone thickening with lytic and sclerotic lesions in the mandibular ramus and mandibular angle. The histological findings of a biopsy specimen led to the diagnosis of osteomyelitis, but the results of bacteriological examination of bone marrow were negative. We diagnosed DSO, and roxithromycin was administered orally for 11 months. However, the symptoms did not improve. In March 2009, we performed decortication of the affected mandible with the patient under general anesthesia. However, the symptoms recurred 2 months after surgery. In July 2010, we intravenously administered pamidronate, with the approval of the Tokyo Medical University Hospital institutional review board. The patient’s symptoms improved the next day. Approximately 4 years after the treatment, the symptoms have not recurred, and no lesions have been detected on radiographic imaging.