Bone pathology I - inflammatory disease of bone - ostemyelitis Flashcards
common or rare?
rare due to antibiotics
local predisposing factors?
increase risk of osteomyelitis
decreased bone vascularity/vitality
Trauma
Radiation injury
Paget’s disease
Osteopetrosis
Major vessel disease
systemic predisposing factors?
increase risk of osteomyelitis
impaired host defence
Immune deficiency states
Immunosuppression
Diabetes mellitus
Malnutrition
Extremes of age
what is osteomyelitis?
spectrum of inflammatory and reactive changes in the bone and periosteum
suppurative osteomyelitis?
- Acute and chronic.
- Source of infection: focus of infection associated with teeth or with local trauma.
- Mixed infection including anaerobic bacteria predominate.
- Mandible more frequently involved due to the readily
compromised blood supply. - Once in the bone, the organisms proliferate in the marrow
spaces leading to an acute inflammatory reaction. - Inflammation, tissue necrosis and suppuration.
- Marrow spaces filled with pus.
source of infection for suppurative osteomyeltis?
tooth related
extraction, RCT, trauma (fracture)
what bacteria dominate in suppurative osteomyelitis?
anaerobic
what happens when inflammation reaches the periosteum in suppurative osteomyelitis?
- Inflammation may spread and reach the periosteium.
- Stripping of the periosteum compromises blood supply, leading
to further bone necrosis. - body tries to contain it by forming bony Sequestrum formation, separated by osteoclasts.
- Sequestra exfoliated through a sinus, or surgically removed.
bony sequestra?
A sequestrum is a piece of dead bone that has become separated during the process of necrosis from normal or sound bone. It is a complication of osteomyelitis.
osteoclasts try to separate necrotic bone from healthy bone
radiographic appearance of suppurative osteomyelitis
- The appearance may be normal during the early stages.
- After 10-14 days, enough bone resorption may have
occurred to produce irregular moth eaten areas of
radiolucency.
disease?
Suppurative Osteomyelitis
describe the bone resorption in suppurative osteomyelitis?
moth eaten
disease shown?
suppurative osteomyelitis
what are the arrows pointing to and what disease is shown?
bone sequestra
separation of bone - necrotic and healthy bone
SUPPURATIVE OSTEOMYELITIS - MOTH EATEN APPEARANCE
Clinical presentation of acute suppurative osteomyelitis?
- Acute inflammation
- Pain
- Swelling
- Pyrexia
- Malaise
- Trismus
- Parasthesia in lip
- Mobility of teeth if bone resorption is excessive
MORE SEVERE
Pts are very unwell with osteomyelitis
Clinical presentation of chronic suppurative osteomyelitis?
- Chronic inflammation
- Swelling
- Pain
- Chronic suppuration
- Discharge of pus
- Intraoral sinuses
- Extraoral sinuses
longer it stays sinus formation and pus discharge
histopathologically?
- Acute inflammation, necrosis and suppuration.
- Inflammation extended to the marrow spaces.
- Formation of sequestra.
- Involvement of the periosteium.
what is formed if immune system in pt strong and have osteomyelitis?
counteract bone resorption by forming many layers
forming sclerosing osteomyelitis
what is shown?
suppurative osteomyelitis
what is sclerosing osteomyelitis?
- Localized lesions are
identical to focal sclerosing osteitis. - Diffuse sclerosing regions a complication of spread of a low grade infection or inflammation.
counteract bone resorption by forming many layers
occurs if low grade infection and host has good immune response
what can you see here?
sclerosing osteomyelitis
enlargement of jaw
layers of bone being deposited
specific type of sclerosing osteomyelitis?
Garre’s Osteomyelitis, Periostitis Ossificans
what does Garre’s Osteomyelitis, Periostitis Ossificans affect?
periosteum only
what is Garre’s Osteomyelitis, Periostitis Ossificans?
- Mandible in children and young adults.
- A proliferative sub-periosteal reaction to the spread of low
grade, chronic apical inflammation through the cortical bone.
clinical presentation of Garre’s Osteomyelitis, Periostitis Ossificans?
- Bony hard swelling on the outer surface of the mandible
histopathology of Garre’s Osteomyelitis, Periostitis Ossificans?
- Irregular trabiculae of actively forming woven bone.
- Scattered chronic inflammatory infiltrate in the fibrous
marrow.
radiographic appearance of Garre’s Osteomyelitis, Periostitis Ossificans?
- In Occlusal radiographs, a focal
subperiosteal overgrowth of bone. - Smooth surface on the outer cortical
plate.
what is shown here?
infected tooth periapical lesion
with sclerosing layer of bone forming underneath
= Garre’s Osteomyelitis, Periostitis Ossificans
what is shown here?
Garre’s Osteomyelitis, Periostitis Ossificans
what is shown here?
onion skin appearance
many later of bone forming in response to low-grade irritation
not really osteomyelitis
= Garre’s Osteomyelitis
Is Garre’s Osteomyelitis a true osteomyelitis?
no
