Bone lesion
The timelines for resolution (where possible) for bone lesions is reflected by the original pathology and the treatment. These are very general guidelines and the process will be quite specific to the individual and their condition.
Infections, inflammatory and other non-neoplastic bone lesions
Dry socket (alveolar osteitis)
This frustratingly painful condition tends to fully resolve in 7 to 10 days. It may rarely persist as some form of osteomyelitis which can then be quite unpredictable.
Osteomyelitis
Acute osteomyelitis generally improves dramatically over a few days after effective treatment but it is not unusual for complete resolution to take up to 2 weeks with an aching discomfort associated with the area affected.
If pathological fractures are associated with osteomyelitis, rigid fixation is shown to improve healing. This creates a second insult to the healing jaw and although the symptoms are initially dramatically improved, associated swelling and discomfort can add an additional week to healing. If there is association nerve damage this may be symptomatic for many months.
There are a range of chronic osteomyelitis conditions. The common guiding principle in the healing process seems to be that it is lengthy and frustrating with apparent healing followed by periods of hard to explain return of symptoms. This is unfortunate but most people do seem to gradually improve in the long term (months to years).
Garré’s sclerosing osteomyelitis is a frustrating and unpredictable condition, affecting mostly young people. It does eventually resolve after treatment and does not seem to progress in adulthood.
Chronic sclerosing osteomyelitis is very unpredictable with little real understanding of the underlying pathological mechanisms. Treatment is often along common sense guidelines and ‘in hope’. Symptom-free periods can be blighted by relapse even after years of apparent ‘cure’. The real problems are the management of pain, which may be due to some form of autonomic nerve dysfunction (a degree of malfunction of involuntary nerve actions) and the maintenance of a positive attitude in the face of a very frustrating and currently hard to explain condition.
Cysts
Despite the huge variation in types of jaw bone cysts they are usually managed by simple enucleation. These heal symptomatically within a week or two (depending on size and degree of surgery), and the cavity gradually fills with normal bone over a 6 month period. Marsupialised cysts follow essentially the same course but are more irritating because of the connection with the mouth.
Fibrous dysplasia and ossifying fibroma
Substantial swelling taking 2 to 3 weeks to fully resolve is the usual problem associated with bone re-sculpting or excision of an ossifying fibroma. Long term, the main issue is recurrence of areas affected by fibrous dysplasia.
Osteopetrosis
An awareness of the condition and the possibility of the need for intervention at some point in life is the most pertinent point.
Paget’s disease of bone
Another life long condition where an awareness of the condition is probably the only predictable feature in terms of timelines.
Benign neoplastic bone lesions (benign bone tumours)
Ameloblastoma
The timeline will vary depending on the degree of surgical intervention.
Unicystic ameloblastoma treated by enucleation responds and follows a healing course much like that of a large cyst. Recurrence is relatively unlikely.
Multilocular ameloblastoma may be treated by resection which will involve a longer healing period than simple enucleation (2 to 4 weeks). There will be a direct effect on chewing if teeth in the area of the resection are included and may, rarely, be complicated by a reconstruction which will have its own timeline.
Other odontogenic benign tumours (such as adenoameloblastoma, myxoma, or ameloblastic fibroma) are all extremely rare. They are all managed by conservative excision and follow a similar healing path to ameloblastoma.
Bizarre parosteal osteochondromatous proliferation (Nora’s lesion)
A rare condition, which may follow a simple path like excision of a torus or be as complicated as chronic sclerosing osteomyelitis (see above).
Giant cell granuloma of bone
Simple excision usually heals with minimal residual symptoms within 2 to 4 weeks.
Osteoma / Gardner’s syndrome / Torus
These entirely benign bony exostoses are excised and heal uneventfully within a few weeks, but swelling is to be expected which can be quite dramatic for the first few days, then more slowly settles over a period of 10 to 14 days.
Malignant neoplastic bone lesions (bone cancers)
Sarcoma, the malignant conditions affecting connective tissue are managed essentially along the same lines as soft tissue cancers of the head and neck. Liposarcoma follows the same timeline as mouth cancer with the exception that radiotherapy is not usually involved.
Osteosarcoma, the malignant conditions affecting the jaw bones has a degree of controversy as pre-operative chemotherapy is used for long-bone sarcoma but has never been proven to be of survival benefit (and if poorly handled can delay definitive surgery). However the data is conflicting and generally of poor quality.
Intuitively, a planned trial of pre-operative chemotherapy the effectiveness (or otherwise) of which can be confirmed on the resected specimen all carried out as part of a planned timeline would make sense and is practiced in some centres. This would usually involve two cycles of chemotherapy, closely monitored, followed by planned ablative and reconstructive surgery which is effectively the same as that for mouth cancer. Timelines for these conditions are included in the discussion of timelines for mouth cancer, and timelines for the treatment of tumour metastases.
If the chemotherapy has resulted in necrotic tumour in the excised specimen, it may be continued; if not and the surgical margins are clear there is no justifiable reason to run further risk of chemotherapy-induced unwanted effects such as neuropathies. The only disadvantage to this approach is if the chemotherapy is ineffective and/or produces adverse effects, definitive surgery (which is the primary curative treatment) has been delayed.