{"id":9049,"date":"2026-04-07T11:06:43","date_gmt":"2026-04-07T11:06:43","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/marieke-van-de-meent\/"},"modified":"2026-04-23T08:25:10","modified_gmt":"2026-04-23T08:25:10","slug":"marieke-van-de-meent","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/marieke-van-de-meent\/","title":{"rendered":"Marieke Van De Meent"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":13537,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-9049","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Chronic diffuse sclerosing osteomyelitis\/tendoperiostitis of the mandible","samenvatting":"Er is geen Nederlandse samenvatting beschikbaar. De Engelse samenvatting vind je hier<\/a>.","summary":"Chapter 1 provides a general introduction about Chronic Diffuse Sclerosing Osteomyelitis (DSO) of the mandible. The history, classification and clinical implications of different types of osteomyelitis are described. Aetiology, clinical features, radiography, histopathology, microbiology, and treatment of DSO of the mandible are described. DSO of the mandible is a relatively rare disease and the exact aetiology is uncertain. One hypothesis is that of overuse of the masticatory muscles, also known as chronic tendoperiostitis (TP).\n\nThis thesis aims to evaluate the diagnostic examination and treatment with long-term therapeutic effect of patients with DSO\/TP of the mandible. Furthermore, with the hypothesis of chronic tendoperiostitis as possible aetiologic factor, this thesis aims to facilitate research with treatments based on this hypothesis and to facilitate a standard of care approach for clinicians. This could prevent unnecessary diagnostic examination and treatments.\n\nIn chapter 2, radiographic characteristics of DSO\/TP of the mandible are investigated and compared with the radiographic characteristics of Chronic Suppurative Osteomyelitis (CSO) and osteoradionecrosis (ORN) in order to radiographically distinguish these three diseases. This retrospective study included 33 patients (13 DSO\/TP, 6 CSO, 14 ORN) of which osseous and soft tissue changes were analysed on panoramic radiographs, computed tomography- and magnetic resonance images. Patients with DSO\/TP showed extensive sclerosis with subperiosteal bone formation, condylar process deformation, and hypertrophy and oedema of the masseter muscle. No pathological fractures or sequestra were observed in patients with DSO\/TP of the mandible. These radiographic characteristics differentiate DSO\/TP of the mandible from CSO and ORN. These osseous and soft tissue changes support the aetiology of chronic tendoperiostitis due to overuse of the masticatory muscles.\n\nIn chapter 3 a systematic review of the literature regarding different treatment strategies for patients with DSO\/TP of the mandible is provided. After a systematic electronic database search, 48 articles could be included. Reported treatment options included surgical approaches, antibiotics, anti-inflammatory-, and antiresorptive medication, conservative treatment, and hyperbaric oxygen treatment. Surgical treatment resulted in low success rate and was associated with higher morbidity than other treatments. Conservative- and bisphosphonate treatment showed more promising results. Because these are less invasive, we advise considering conservative- and bisphosphonate treatment as the first and second choice for treatment of DSO\/TP of the mandible.\n\nChapter 4 presents a retrospective study to test the hypothesis that overuse of the masticatory muscles, TP, is a contributing factor for DSO of the mandible by treating children with conservative therapy (occlusal splint therapy, physiotherapy, and\/or disease counselling). Pain intensity and pain frequency were recorded before the start of treatment, and at 3, 6 and 12 months. Eleven children were included, of whom six patients (55%) showed decrease in pain intensity and pain frequency. Five patients reported persistent severe pain, and were started on bisphosphonate therapy. Conservative treatment can result in significant improvement of symptoms and thus supports the hypothesis that DSO\/TP of the mandible is possibly initiated and exacerbated by muscle overuse. Therefore, we recommend to treat patients with DSO\/TP of the mandible for at least 6-12 months with conservative therapy.\n\nIn chapter 5 conservative- or non-surgical therapy is investigated in adult patients with DSO\/TP of the mandible. Sixteen patients were included, and in 12 patients the non-surgical therapy led to remission, the other four patients started with intravenous bisphosphonates. Also in adult patients, conservative- or non-surgical therapy can result in significant improvement of symptoms, and strengthen the hypothesis of chronic tendoperiostitis. Therefore, we advise to start with conservative- or non-surgical therapy as a first-line treatment for DSO\/TP of the mandible in both children and adult patients.\n\nChapter 6 describes an evaluation of short-term and long-term results of patients with DSO\/TP of the mandible treated with bisphosphonates. Eighteen patients were included, of whom 16 patients showed improvement of symptoms (pain, swelling of the cheek, trismus, and tenderness of masticatory muscles) after the start of bisphosphonate treatment. Two patients were lost to follow-up. Therefore, we advise bisphosphonate treatment for patients refractory to conservative therapy.\n\nChapter 7 presents the results of remodelling surgery with three-dimensional (3D) designed- and -printed patient-specific surgical guides for patients with DSO\/TP of the mandible, who had complaints about facial asymmetry caused by mandibular deformity. This 3D surgical guides are designed and manufactured by using the mirror image of the contralateral healthy mandible. Four cases are described, of whom three patients underwent the surgery with 3D printed patient-specific guides. In the other patient the surgery was postponed, because she was in doubt about the surgery. The use of these patient-specific guides could enable a more predictable and symmetrical outcome, which could minimise the chance for re-surgery and iatrogenic damage (injury to the inferior alveolar nerve), and could increase patient satisfaction.\n\nIn chapter 8 conclusions, a proposal for a standard of care protocol and future perspectives are discussed.","auteur":"Marieke Van De Meent","auteur_slug":"marieke-van-de-meent","publicatiedatum":"22 oktober 2024","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/mariekevandemeent?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604071104","isbn":"978-94-6510-073-9","doi_nummer":"","naam_universiteit":"Universiteit Leiden","afbeeldingen":13537,"naam_student:":"","binnenwerk":"","universiteit":"Universiteit Leiden","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9049","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=9049"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9049\/revisions"}],"predecessor-version":[{"id":9050,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/9049\/revisions\/9050"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/13537"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=9049"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=9049"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}