This document discusses osteomyelitis of the jaws, including its definition, causes, pathogenesis, types, clinical features, radiology, and management. Osteomyelitis is an inflammatory process in the bone marrow or cortical surfaces of bone. It can be caused by local factors like trauma or radiation injury as well as systemic factors like diabetes or immunosuppression. Types include suppurative, focal sclerosing, diffuse sclerosing, and proliferative periostitis. Clinical features and radiographic findings are described for diagnosis. Management involves antibiotics, drainage, debridement, and surgery if needed.
This document discusses osteomyelitis of the jaws, including its definition, causes, pathogenesis, types, clinical features, radiology, and management. Osteomyelitis is an inflammatory process in the bone marrow or cortical surfaces of bone. It can be caused by local factors like trauma or radiation injury as well as systemic factors like diabetes or immunosuppression. Types include suppurative, focal sclerosing, diffuse sclerosing, and proliferative periostitis. Clinical features and radiographic findings are described for diagnosis. Management involves antibiotics, drainage, debridement, and surgery if needed.
This document discusses osteomyelitis of the jaws, including its definition, causes, pathogenesis, types, clinical features, radiology, and management. Osteomyelitis is an inflammatory process in the bone marrow or cortical surfaces of bone. It can be caused by local factors like trauma or radiation injury as well as systemic factors like diabetes or immunosuppression. Types include suppurative, focal sclerosing, diffuse sclerosing, and proliferative periostitis. Clinical features and radiographic findings are described for diagnosis. Management involves antibiotics, drainage, debridement, and surgery if needed.
This document discusses osteomyelitis of the jaws, including its definition, causes, pathogenesis, types, clinical features, radiology, and management. Osteomyelitis is an inflammatory process in the bone marrow or cortical surfaces of bone. It can be caused by local factors like trauma or radiation injury as well as systemic factors like diabetes or immunosuppression. Types include suppurative, focal sclerosing, diffuse sclerosing, and proliferative periostitis. Clinical features and radiographic findings are described for diagnosis. Management involves antibiotics, drainage, debridement, and surgery if needed.
Geeta Kalra (H.O.D of department of oral and maxillofacial surgery) Osteomyelitis Of Jaws Presented By: Anuradha B.D.S final year INDEX • WHAT IS OSTEOMYELITIS. • FACTORS PREDISPOSING TO OSTEOMYELITIS. • PATHOGENESIS OF OSTEOMYELITIS. • TYPES OF OSTEOMYELITIS.
❑ PATHOGENESIS ❑ CLINICAL FEATURES ❑ HISTOLOGY ❑ RADIOLOGY ❑ MANAGEMENT OSTEOMYELITIS INTRODUCTION ❖ OSTEOMYELITIS is an acute & chronic inflammatory process in the medullary spaces or cortical surfaces of bone that extends away from the initial site of involvement.
❖ Osteomyelitis of the jaws is basically
a infection and inflammation of the bone marrow , sometimes abbreviated to OM that occurs in jaws. Factors predisposing to osteomyelitis. ❑ LOCAL FACTORS ❑SYSTEMIC FACTORS 1. TRAUMA. 1. IMMUNE DEFICIENCY STATES. 2. RADIATION INJURY. 2. IMMUNOSUPPRESSION. 3. PAGET'S DISEASE. 3. DIABETES MELLITUS. 4. OSTEOPOROSIS. 4. MALNUTRITION. 5. MAJOR VESSEL DISEASE. 5. EXTREMES OF AGE. PATHOGENESIS OF OSTEOMYELITIS 1. Inflammatory process of entire bone including cortex & periosteum , not just confined to endosteum.
2. Inflammatory condition beginning in
medullary cavity & havarsian system & extending to involve periosteum of affected area.
3. Local factors decreases the vitality of bone.
4. Systemic conditions comprises the defense
system of the host. TYPES OF OSTEOMYELITIS • SUPPURATIVE OSTEOMYELITIS.
• FOCAL SCLEROSING OSTEOMYELITIS.
• DIFFUSE SCLEROSING OSTEOMYELITIS.
• PROLIFERATIVE PERIOSTITIS. SUPPURATIVE OSTEOMYELITIS • Source of infection- Usually adjacent focus of infection associated with teeth or with local trauma. • It is a polymicrobial infection, predominating anaerobes such as Bacteriods , porphyromonas or provetella. • Staphylococci may be cause when an open fracture is involved. • Mandible is more prone than maxilla as vascular supply is readily compromised.
Cropped panoramic radiograph of suppurative osteomyelitis at the right side of mandible. ACUTE SUPPURATIVE OSTEOMYELITIS • Stages how acute suppurative osteomyelitis occurs… 1. Organisms entry into the jaw, mostly mandible, compromising the vascular supply. 2. Medullary infection spreads through marrow spaces. 3. Thrombosis in vessels leading to extensive necrosis of bone. 4. Lacunae empty of osteocytes but filled with pus, proliferate in the dead tissue. 5. Suppurative inflammation extend through the cortical bone to involve the periosteum. 6. Stripping of periosteum comprises blood supply to cortical plate, predispose to further bone necrosis. 7. Sequestrum is formed bathed in pus, separated from surrounding vital bone. CLINICAL FEATURES ❑EARLY: o Severe throbbing , deep-seated pain o Swelling due to inflammatory edema. o Gingiva appears red , swollen & tender.
❑LATE: • Distension of periosteum with pus.
❑FINAL: o Subperiosteal bone formation cause swelling to become firm. RADIOGRAPHIC FEATURES • May be normal in early stages of disease. • Do not appear until after at least 10 days.
Radiograph may demonstrate
ill-defined radiolucency.
After sufficient bone
resorption irregular, moteaten areas of radiolucency may appear. MANAGEMENT ESSENTIAL MEASURES ADJUNCTIVE TREATMENT • Bacterial sampling & • Sequestrectomy. culture. • Decortication (if necessary) • Emperical antibiotic • Hyperbaric oxygen. treatment. • Resection & reconstruction • Drainage. for extensive bone • Analgesics. destruction. • Specific antibiotics based on culture & sensitivity. • Debridement. • Remove source of infection , if possible, CHRONIC SUPPURATIVE OSTEOMYELITIS • Inadequate treatment of acute osteomyelitis • Periodontal diseases • Pulpal infections • Extraction wounds • Infected fractures
✓Spread of Chronic Suppurative osteomyelitis.
1. Infections in the medullary spaces spread and form
granulation tissue. 2. Granulation tissue forms dense scar to wall off the infected area. 3. Encircled dead space acts as a reserviour for bacteria & antibiotics have great difficulty reaching the site. CLINICAL FEATURES ➢Swelling ➢Pain ➢Sinus formation ➢Purulent discharge ➢Sequestrum formation ➢Tooth loss ➢Pathologic fracture RADIOLOGY • Patchy, ragged & ill defined radiolucency. • Often contains radiopaque sequestra.
• Sequestra lying close to
the peripheral sclerosis & lower border.
• New bone formation is
evident below lower border. FOCAL SCLEROSING OSTEOMYELITIS • Also known as “condensing osteitis”. • Localized areas of one sclerosis. • Bony reaction to low-grade peri-apical infection or unusually strong host defensive response. • Association with an area of inflammation is critical. CLINICAL FEATURES 1. Children & young adults are affected. 2. In mandible , premolar & molar regions are affected. 3. Bone sclerosis is associated with non-vital or pulpitic tooth. 4. No expansion of the jaw. RADIOLOGY ▪ Localized but uniform increased radiodensity related to tooth. ▪ Widened periodontal ligament space or peri-apical area. ▪ Sometimes an adjacent radiolucent inflammatory lesion may be present.
Increased areas of radiodensity surrounding apices of non-vital mandibular first molar. MANAGEMENT • Elimination of the source of inflammation by extraction or endodontic treatment. • If lesion persists and periodontal membrane remains wide, re-evaluation of endodontic therapy is considered. • After resolution of lesion, inflammatory focus is termed as bone scar. DIFFUSE SCLEROSING OSTEOMYELITIS
• It is an ill-defined , highly controversial,
evolving area of dental medicine. • Exact etiology is unknown. • Chronic intraosseous bacterial infection creates a smoldering mass of chronically inflamed granulation tissue. CLINICAL FEATURES 1. Arises exclusively in adult-hood with no sex pre-dominance. 2. Primarily occurs in mandible. 3. No pain. 4. No swelling. RADIOLOGY • Increased radiodensity may be seen surrounding areas of lesion.
Diffuse area of increased radiodensity of RT. Side of mandible MANAGEMENT 1. Elimination of originating sources of inflammation via extraction & endodontic treatment. 2. Sclerotic area remain radiographically. PROLIFERATIVE PERIOSTITIS ❖Also known as “Periostitis ossificans” & “Garee’s osteomyelitis”. ❖It represents a periosteal reaction to the presence of inflammation. ❖Affected periosteum forms several rows of reactive vital bone that parallel each other & expand surface to altered bone. CLINICAL FEATAURES 1. Affected patients are primarily children & young adults. 2. Incidence is mean age of 13 years. 3. No sex predominance is noted. 4. Most cases arise in the premolar & molar area of mandible. 5. Hyperplasia is located most commonly along lower border of mandible. 6. Most cases are uni-focal, multiple quadrants may be affected. RADIOLOGY • Radiopaque laminations of bone roughly parallel each other underlying cortical surface. • Laminations may vary from 1-12 in number. • Radiolucent separations often are present between new bone & original cortex, MANAGEMENT ❖Removal of infection. ❖After infection has resolved, layers of bone will consolidate in 6-12 months. SURGICAL MANAGEMENT Incision and drainage of abscess formation Extent of surgery
Removal of loosened teeth, foreign bodies/
implants and sequestra Local curettage and saucerization of the infected bone Decortication Resection and reconstruction SURGICAL TECHNIQUE FOR SAUCERIZATION • Access to the bone by creating a mucoperiosteal flap, usually using a gingival crest incision. • Refection of flap should be as limited as possible to preserve local blood supply. • Affected teeth (loosened and other dental foci within affected area) are extracted. • The lateral cortex of the mandible is reduced using burs or rongeurs, until the sufficient bleeding bone is encountered at all margins , approximately to the level of unattached mucosa, thus producing a saucer-like defect. • Local debrided area is thoroughly irrigated with sterile saline solution with or without additional antibiotic such as neomycin. • If there is substantial local bleeding due to hyperemia caused by the inflammatory process , a medicated pack may be placed and serve as local compression device. • The buccal flap is trimmed and a medicated pack(such as iodoform gauze lightly covered with antibiotic and local steroid ointment is placed for hemostasis and to maintain the flap in a retracted position. The pack is placed firmly without pressure and retained by several non-resorbable sutures, extending over the pack from the lingual to the buccal flap. • The pack is remained in situ for several days up to 2 weeks or even more in some instances and may be replaced several times, until the surface of the bed of granulation tissue is epithelialized and the margins have healed.
Prevention of Odontogenic Infection - Principles of Management - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
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Prevention of Odontogenic Infection - Principles of Management - Dental Ebook & Lecture Notes PDF Download (Studynama - Com - India's Biggest Website For BDS Study Material Downloads)
Get Overcoming Tendonitis A Systematic Approach to the Evidence Based Treatment of Tendinopathy 1st Edition Steven Low PDF ebook with Full Chapters Now
