The Moth-Eaten Mandible: Osteomyelitis

Inflammatory lesions such as osteomyelitis of the jaw may share some of the radiographic features of malignancy; however, a demonstrable dental cause for it usually exists. In addition, inflammatory lesions generally stimulate a sclerotic bone reaction, which is uncommon in malignancy. The imaging modality of choice for aiding in the differential diagnosis is computed tomography imaging because of its ability to clearly delineate sequestra and periosteal new bone formation.

Hypertrophic Osteoarthropathy

Chapter 69 discusses hypertrophic osteoarthropathy (HOA), which is a clinical triad of periostitis, digital clubbing, and swollen joints. When caused by an underlying pulmonary disease, it is termed hypertrophic pulmonary osteoarthropathy (HPOA). HPOA is most commonly associated with neoplastic lung disease, however, HOA has also been described with cyanotic congenital heart disease, cirrhosis, biliary atresia, inflammatory bowel disease, gastrointestinal polyposis, and thalassemia. The principal imaging finding in HPOA is periostitis and periosteal new bone formation affecting the long bones of the appendicular skeleton in a bilateral and symmetric fashion. Radiographically this manifests as a smooth layer of periosteal new bone formation. Bone scintigraphy demonstrates a characteristic linear radiotracer uptake parallel to the normal cortical bone uptake known as the parallel track or double line sign. MRI similarly demonstrates hyperintense linear periosteal STIR signal that parallels the affected long bones.

A study of nonspecific skeletal health indicators in two nonadult populations from western Britain

Skeletal health indicators are often employed to measure how past populations adapted to their physical environment. The skeletons of children provide a measure of population fitness, as the ability of a community to keep their younger inhabitants alive and in general good health attest their ability to adapt to their environment. In this study, skeletal remains of non-adults from foetal to 17 years of age (n=300) from two cemetery populations in western Britain, namely the early medieval site of Llandough in south Wales (n=204) and the multi-period site of St Oswald’s Priory in Gloucester (n=96), were assessed. Non-specific indicators of physiological stress (cribra orbitalia, porotic hyperosprotosis, dental hypoplasia) and non-specific infections (periosteal new bone formation and endocranial lesions) are compared. Results suggest that the children from the English site enjoyed better health than their counterparts in Wales, where there was an increase in physiological stress during childhood.

Bilateral angular carpal deformity in a dog with craniomandibular osteopathy

SummaryA four-month-old West Highland White Terrier was presented to the Small Animal Teaching Hospital at the University of Liverpool with the complaint of a bilateral angular carpal deformity. A 20° valgus deformity was present in both thoracic limbs, centred on the distal radial physes. Both distal ulnas were grossly thickened and there was concomitant thickening of the rostral mandible and calvarium. The dog exhibited signs of resentment on palpation of the mandible and signs of pain were elicited on flexion and extension of both elbow joints. No signs of pain were evident on palpation of the ulnas or calvarium. Radiographic images of both ulnas showed marked amorphous periosteal new bone formation. The distal ulnar physes were closed centrally and both elbow joints had humeroulnar subluxation. Radiographic changes to the calvarium and mandibular rami were consistent with a diagnosis of craniomandibular osteopathy. A bilateral ulna ostectomy was performed to correct the angular limb deformity and elbow subluxations. Histology of the ostectomised pieces showed changes consistent with craniomandibular osteopathy.