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International Arab Journal of Dentistry

Abstract

Objectives: Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder predominantly affecting pediatric and adolescent populations. The clinical presentation is heterogeneous, with persistent pain and swelling representing the most frequent and often initial symptoms. These manifestations are commonly localized to the mandible, although involvement of other skeletal sites, including long bones, clavicle, and vertebrae, may occur in more advanced cases. Beyond localized symptoms, some patients exhibit mild systemic features such as low-grade fever, fatigue, or malaise; however, these systemic signs are generally less pronounced than those observed in infectious osteomyelitis. The diagnostic evaluation of CNO is intricate and necessitates a systematic, multi-modal approach. Clinicians must integrate clinical assessment with imaging and laboratory investigations. Radiological modalities, particularly computed tomography (CT), are instrumental in delineating the extent and distribution of osseous lesions. In select cases, bone biopsy is indispensable to exclude differential diagnoses such as primary bone malignancies or metastatic disease. Histopathological examination and microbiological cultures derived from biopsy specimens are critical for confirming the absence of infectious pathogens, thereby facilitating the differentiation of CNO from bacterial osteomyelitis.

Methods: Between 2016 and 2024, a total of 52 pediatric patients (comprising 18 males and 34 females) aged 5 to 17 years, presenting with diverse anthropometric characteristics, were admitted to the maxillofacial department of the Russian Children’s Clinical Hospital, a branch of the Russian National Research Medical University named after N.I. Pirogov in Moscow, with a provisional diagnosis of CNO. These patients underwent a comprehensive multi-stage diagnostic protocol aimed at confirming or excluding the suspected diagnosis. The evaluation process included clinical assessment and medical history review, as well as laboratory investigations encompassing radiological imaging, bacteriological analysis, and morphological examination of excised bone specimens.

Conclusion: While there have been efforts documented in the literature to develop criteria and streamline the diagnostic process for CNO, it is premature to assert that these initiatives are widely recognized and implemented on a global scale.

Results: Of the 52 patients, 65.38% were female (mean age 10.21 years) and 34.61% were male (mean age 11.11 years). The mandible—particularly the left body and ramus—was the most commonly affected site, with symptoms including trismus, bone pain, edema, and Vincent’s symptom. Imaging and histology supported an autoinflammatory process, and 60.52% of cultures were negative, confirming the non-bacterial nature of the disease.

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