# Mandibular reconstruction in a patient with SAPHO syndrome

Julien Delrieu, Rémi Esclassan, Thibault Canceill

► To cite this version:

Julien Delrieu, Rémi Esclassan, Thibault Canceill. Mandibular reconstruction in a patient with SAPHO syndrome. International Journal of Rheumatic Diseases, 2023, 26 (9), pp.1870 - 1871. 10.1111/1756-185x.14653 . hal-04786679

HAL Id: hal-04786679

https://hal.science/hal-04786679v1

Submitted on 20 Feb 2025

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WILEY

Mandibular reconstruction in a patient with SAPHO syndrome

The article published by Yuchen Liu et al in December 2022 is, to our knowledge, the first to describe the case of a patient suffering from a mandibular-localized SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome and treated with tofacitinib.¹ The authors well explain the history of the woman's disease even if they only had to receive her recently. Between the years 2004 and 2009, several surgical interventions had been performed to result in a complete mandible resection. Due to her syndrome, the patient had developed sclerosing osteomyelitis on oral bones, associated with pain and difficulties in swallowing. After the oral administration of tofacitinib during 3 months, the authors could note a significant reduction of the symptoms.

In addition to the remarkable and rapid management by the authors' department, additional information could be provided concerning the patient's oral rehabilitation. Anton Warshavsky et al have indeed highlighted in 2019 the impact of mandibular resection and reconstruction on patient's quality of life.² They have also noted that the results were site dependent.³ In the case of the present article, the simple observation of the photography proposed by the authors before lower jaw reconstruction is enough to imagine the difficulties that the patient may have encountered socially and functionally to eat. In particular, this point should be considered in the context of the 11 years that elapsed between her surgeries and the beginning of the tofacitinib treatment. In such situations, assessments of the patient's general and oral quality of life could be conducted retrospectively at first and then after rehabilitation during follow-up. The patient's image after “cosmetic” management (as defined by Liu et al) demonstrates the aesthetic quality of the procedures performed. However, a more detailed description of what was proposed and achieved in the patient would allow future medical teams to complete their management of patients with SAPHO syndrome. Is it possible to envisage a new surgery, this time with a reconstructive aim, in a patient whose healing capacities are known to be altered? What are the possible risks of rejection if any kind of graft is considered? It is also intriguing to know why no rehabilitation was undertaken beforehand and for more than 10 years.

The best of the conclusions can be found in the review published by Batchu Pavan Kumar et al in 2015 in which they reminded that the aim of mandibular reconstruction must be to bring a new

viable mandible to the patient, in terms of form and relationship with the upper jaw.⁴

AUTHOR CONTRIBUTIONS

JD, RE, TC: Analysis of the initial article. JD: Write of the first draft.

RE, TC: Corrections and validation. TC: Project administration.

KEYWORDS

mandibular reconstruction, SAPHO syndrome

ACKNOWLEDGMENTS

None.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to declare.

Julien Delrieu¹

Rémi Esclassan¹,²

Thibault Canceill¹,³ ID

¹Toulouse Health Faculty, Odontology Department, Paul Sabatier University, Toulouse, France

²Centre d'Anthropobiologie et de Génomique de Toulouse, Faculté de Médecine Purpan, Université Paul Sabatier Toulouse III, Toulouse, France

³InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm/Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), Toulouse, France

Correspondence

Thibault Canceill, Toulouse Health Faculty, Odontology department, Paul Sabatier University, Toulouse, France.

Email: thibault.canceill@sfr.fr

ORCID

Thibault Canceill ID https://orcid.org/0000-0002-0049-7622

REFERENCES

1. Liu Y, Wu X, Cao Y, Liu S, Ma M, Li C. Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome with mandibular involvement:

<footnote>Comment on: "Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome with mandibular involvement: Would surgical operation help?"</footnote>
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would surgical operation help? *Int J Rheum Dis.* 2023;26:563-567.
doi:10.1111/1756-185X.14542

2. Warshavsky A, Fliss DM, Frenkel G, et al. Long-term health-related quality of life after mandibular resection and reconstruction. *Eur Arch Otorhinolaryngol*. 2019;276:1501-1508.

3. Warshavsky A, Fliss DM, Frenkel G, et al. Quality of life after mandibulectomy: the impact of the resected subsite. *Int J Oral Maxillofac Surg*. 2019;48:1273-1278.

4. Kumar BP, Venkatesh V, Kumar KAJ, Yadav BY, Mohan SR. Mandibular reconstruction: overview. *J Maxillofac Oral Surg*. 2016;15:425-441.