Chronic osteomyelitis mimicking a temporomandibular disorder: a case report of two cases

Chronic osteomyelitis of the jaw is rare in the healthy popula-tions of developed countries and presents with diagnostic and therapeutic challenges. Clinical presentation: Patient 1 pre-sented with a dull, occasionally throbbing pain in the left mandi-ble of 1.5 years duration. There was associated trismus which alternated between improving and worsening. The patient had features mimicking a variant of temporomandibular disorder (TMD). She was misdiagnosed and treated for myogenous TMD without symptom relief. Patient 2 presented with intermittent dull pain with mastication and facial swelling over the right man-dible for 1 year. She was treated by the referring dental practi- tioner for myogenous TMD without symptom relief. Clinical and radiologic findings confirmed a diagnosis of chronic sclerosing osteomyelitis in both cases, and conservative treatment, includ-ing antibiotics, relieved the pain with no signs of recurrence. Con-clusion: The importance of including chronic osteomyelitis in the differential diagnosis of idiopathic orofacial pain disorders is em-phasized. If the management of myogenous TMD is unsuccessful, there is a possibility of a misdiagnosis, and a differential diagno-sis, including chronic osteomyelitis, needs to be reconsidered.(Quintessence Int 2023;54:44-52; doi:10.3290/j. qi. b3479985)