PRIMARY CHRONIC OSTEOMYELITIS OF THE JAW IN CHILDREN: TWO CASE REPORTS

Primary chronic osteomyelitis (PCO) is a rare condition that presents significant diagnostic challenges. It primarily affects children aged 6 to 17 years and can involve various bones, including the mandible. The difficulty in differentiating PCO from infections, tumors, metabolic disorders, and other inflammatory conditions often leads to misdiagnosis, incorrect treatment strategies, and relapses. Currently, there is no standardized treatment protocol for PCO. Most treatment approaches begin with nonsteroidal anti-inflammatory drugs (NSAIDs) aimed at symptom relief. Other treatment options include corticosteroids, methotrexate, bisphosphonates, and tumor necrosis factor-alpha (TNF-α) inhibitors. Monoclonal antibodies, such as denosumab, have demonstrated promising efficacy by targeting the RANKL-RANK system, thereby suppressing osteoclast activity and reducing inflammatory bone resorption. Methods: Between 2015 and 2023, forty-five children were treated for PCO at the Department of Oral and Maxillofacial Surgery, Russian Childrens’ Clinical Hospital, affiliated with the Pirogov Russian National Research Medical University. Of these, 17 children received combination therapy involving resection with removal of all granulomatous tissue, followed by postoperative administration of denosumab. From this group, two patients – a 15-year-old boy and a 6-year-old girl – were selected for this article due to their differing anthropometric characteristics and recurrent disease course. Results: The treatment applied in these two clinical cases effectively increased the density of the affected bone area. However, if small cystic elements were not fully removed and debridement of granulated tissues was insufficient, relapse occurred, necessitating further surgical intervention. Postoperative use of denosumab and ibandronate contributed to maintaining disease remission. Conclusion: It is crucial to determine the appropriate dosage, treatment duration, and drug administration frequency to achieve optimal outcomes and mitigate potential postoperative complications typically associated with the prescribed medications. © 2025 Elsevier B.V., All rights reserved.