“Chronic Recurrent Multifocal Osteomyelitis of the Mandible: A Diagnostic Challenge”

Summary: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disorder of children and adolescents characterized by mono- or multi-focal inflammatory bone lesions that are culture-negative on biopsy, associated with periods of exacerbation and resolution that can last over several months to years. Although it is predominantly a disease of long bones and the spine, craniofacial involvement is not uncommon, affecting the mandible in up to a fifth of cases. Similarities with other etiologies of osteitis in clinical presentation and imaging, as well as the lack of specific symptoms or laboratory tests, make CRMO mainly a diagnosis of exclusion. An accurate diagnosis is required for appropriate treatment in order to induce remission. This manuscript highlights the challenges faced by plastic and oral surgeons in diagnosing mandibular CRMO, and describes two pediatric patients affected with the disease. Both cases were initially confused with other entities, leading to unnecessary initial treatments and a delayed diagnosis. A review aimed at surgeons summarizes the major aspects of this condition so that it is considered as a differential diagnosis in young patients presenting with a facial bony mass. * Camison and Mai are co-first authors Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Joseph E. Losee, MD, FACS, FAAP, Division Chief, Pediatric Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Children's Hospital Drive, 45th & Penn, Pittsburgh, PA. 15224, Phone: 412-692-6203, Fax: 412-692-5263 ©2018American Society of Plastic Surgeons

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