3. Inflammatory diseases of the face and jaws. Tumors.

Question 1

Osteomyelitis of Jaw - Define

Answer 1

It is an inflammatory process in jaw; acute or chronic. It can be in the maxilla or mandible.

Question 2

Osteomyelitis of Jaw - Etiology (5)

Answer 2

Alveolar abscess leading into osteomyelitis.

Recurrent dental infection.

Trauma.

After dental extraction; surgeries of the jaw.

Postradiotherapy osteomyelitis (osteoradionecrosis).

Question 3

Osteomyelitis of Jaw - Types 1/3

Answer 3

Acute is common in children; maxilla or mandible may get involved; swelling,
redness, fullness are the features; pus may trickle through nostril if it is in maxilla.

Question 4

Osteomyelitis of Jaw - Types 2/3

Answer 4

Subacute type is the commonest type; common in adult; apical sepsis, endarteritis,
bone necrosis is the pathology; common in mandible; rare in maxilla due to existing
network vasculature which prevents endarteritis. Compression over inferior dental
nerve causes numbness in chin in area of distribution of mental nerve. Pain,
swelling, tenderness, irregularity, bone thickening are typical.

Question 5

Osteomyelitis of Jaw - Types 3/3

Answer 5

Chronic type is also common in mandible; apical abscess, alveolar abscess, trauma,
radiation, chemicals like phosphorus, tuberculosis, syphilis, actinomycosis are the
causes. Pain, bone thickening, irregularity, discharging sinus, sequestrum in the
discharge, discomfort are the features. Infection from lower incisor causes median
mental sinus. X-ray shows features of osteomyelitis with new bone formation and
sequestrum.

Question 6

Osteomyelitis of Jaw - Management (2)

Answer 6

X-ray jaw; CT scan of jaw; discharge study; ESR are essential investigations. Biopsy
from the sinus is needed often.

It is often difficult to treat. In acute phase, antibiotic coverage, treatment of cause is
done. In chronic type, sequestrectomy, mandibulectomy is needed.

Question 7

Jaw Tumours - Classification - Location 1/4 : Arising from

7

Answer 7

Swelling arising from the gums (Epulis):

i. Congenital epulis.
ii. Fibrous epulis.
iii. Pregnancy epulis.
iv. Giant cell epulis.
v. Myelomatous epulis.
vi. Sarcomatous epulis.
vii. Carcinomatous epulis.

Question 8

Jaw Tumours - Classification - Location 2/4 : Arising from

8

Answer 8

Swelling arising from the dental epithelium (Odontomes):

i. Ameloblastoma.
ii. Compound odontome.
iii. Enameloma.
iv. Cementoma.
v. Dentinoma.
vi. Odontogenic fibroma and myxoma.
vii. Radicular odontome.
viii. Composite odontome.

Question 9

Cysts arising in relation to dental epithelium: (2)

Answer 9

a) Dental cyst.

b) Dentigerous cyst.

Question 10

Jaw Tumours - Classification - Location 3/4 : Arising from

7

Answer 10

Swelling arising from the mandible or maxilla:

i. Osteoma and osteoblastoma.
ii. Torus palatinus and mandibularis.
iii. Fibrous dysplasia.
iv. Osteoclastoma (Common in mandible).
v. Osteosarcoma.
vi. Secondaries.
vii. Giant cell reparative granuloma.

Question 11

Jaw Tumours - Classification - Location 4/4 : Arising from

6

Answer 11

Surface tumours:

a. Tumours from the surface which extend into the jaw.
b. Ossifying fibroma.
c. Osteofibrosis of maxilla.
d. Ivory osteoma of jaw.
e. Leontiasis ossea (diffuse osteitis).
f. Carcinoma extending into the jaw.