Bone Pathology II Flashcards
What is Osteomyelitis
Bone marrow inflammation
Name the various types of Osteomyelitis
- Acute Osteomyelitis
- Chronic osteomyelitis
- Focal sclerosing osteomyelitis (Condensing Osteitis)
- Diffuse sclerosing osteomyelitis
- Osteomyeltis with proliferative periostitis (Garre’s Osteomyelitis)
- Alveolar osteitis (Dry socket)
Clinical presentation of Acute Osteomyelitis
Short duration, usually less than one month
Significant pain usually accompanies it
Systemic symptoms of Acute Osteomyelitis
Fever
Lymphadenopathy
Increased serum [WBC]
Localized symptoms & Characteristics of Acute Osteomyelitis
Swelling of overlying soft tissue
- purulent drainage may be seen
- necrotic bone sequestra may be exfoliated
May cause paresthesia in the distribution of nerves passing through the involved area
Radiographic features of Acute Osteomyelitis
In the earliest stages, no changes are seen
- As the infection progresses, an ill-defined, often asymmetric radiolucency is usually seen
Treatment for Acute Osteomyelitis
- Antibiotics
- Surgical drainage may be necessary if it does not occur spontaneously
Clinic presentation of Chronic Osteomyelitis
- Long duration problem
- Usually not consistent sharp pain but can be variable
- +- Swelling, Purulent drainage, bone sequestration, sinus tract formation
- Tooth loss in area of involvement may be seen
Radiographic features of Chronic Osteomyelitis
- Ill-defined, often asymmetric radiolucency
- Radiopaque internal sequestrum may be seen
- Increased density of the surrounding bone as a reactive response may be seen
Treatment of Chronic Osteomyelitis
Surgical debridement if often necessary
Antibiotics (longer therapy)
*Define Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis)
- Generally considered to be a reaction of periapical bone to low grade odontogenic infection
- Low grade inflammation in an immune competent host can result in increased density (sclerosis) of the bone as the body tries to wall off the infection
** TOOTH IS NON-VITAL
Radiographic features of Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis)
Irregular area of opacity, may be asymmetric and often blends with surrounding bone
Treatment
Address the odontogenic infection (RCT or extraction)
Area may or may not remodel
Define Chronic Diffuse Sclerosing Osteomyelitis
- Controversial bony condition that is often confused with other pathologic conditions, particularly cemento-osseous dysplasia which frequently becomes secondarily infected.
- Considered to be a reaction to low grade odontogenic infection, often following trauma or surgery
*How is Chronic Diffuse Sclerosing Osteomyelitis different from Focal Sclerosing Osteomyeltisis?
They are equivalent but Chronic Diffuse affects a large area of bone in ONE quadrant
*Where does Chronic Diffuse Sclerosing Osteomyelitis usually occur?
Characteristically affects the Posterior Mandible
Radiographic finding of Chronic Diffuse Sclerosing Osteomyelitis:
Diffuse radiopacity of varying density
*Define Chronic Osteomyelitis with Proliferative Periostitis
Also known as Osteomyelitis
- Low grade osteomyelitis with periosteal inflammation that stimulates bone production
- (inflammation involves periosteum)
In what patients is Chronic Osteomyelitis with Proliferative Periostitis commonly found?
Usually younger patients that are immune competent
Clinical presentation of Chronic Osteomyelitis with Proliferative Periostitis
- Draining sinus tract from an infected tooth most often
- On or near the cortical surface
- Mandible most often affected
Radiographic findings of Chronic Osteomyelitis with Proliferative Periostitis
- Immature bone is laid down outside the cortex but under the periostium
- Thin layering of cortical bone produces the expansion
- “Onion skin” pattern
- May see some degree of lucency under the cortex
- Layered bone is weakly opaque, usually less dense than cortical bone
- Often requires occlusal films to visualize the layering of the bone
Treatment of Chronic Osteomyelitis with Proliferative Periostitis
Eliminate the source of infection
Describe Alveolar Osteitis
Also known as Dry Socket
- Post extraction complication caused by loss/breakdown of the blood clot in the socket
Clinical presentation of Alveolar Osteitis
- Often associated with complicated/traumatic extraction
- Mandibular third molars usually
- More likely in sites of infection
- Exposed bone visible without soft tissue covering
- Produces severe pain and a foul odor
What drugs are associated with Bisphosphonate-induced osteonecrosis (MRONJ)
Drugs that inhibit action of osteoclasts
- Decreases bone turnover
- Also known to inhibit angiogenesis and oxygenation
- Amino ones are primary offender
In what cases are medications that may induce MRONJ indicated
- Any attempt to control malignant disease in bone or hypercalcemia of malignancy
- Multiple myeloma
- Metastatic disease, particularly breast and prostate carcinoma
- To increase bone density in older individuals suffering from osteoporosis
- In the treatment of Paget’s disease and other metabolic bone diseases
T or F, ALL bisphosphonate drugs have been implicated in MRONJ
True
- Incidence is dose dependent
- Individual daily dosage and total lifetime dosage
*What things increase the risk for MRONJ when patients have myeloma or metastatic breast cancer?
- Nitrogen containing compounds produces greater risk
2. IV route of administration produces greater risk
Clinical presentation of MRONJ
Bone necrosis Often follows surgical procedures May occur spontaneously Often will not heal or resolve despite all attempts at tx NO unique histologic features
Treatment of MRONJ
Prevention and informed consent important!
- Good oral hygiene
- Control pain
- Control infection
- Antibiotic mouth rinses helpful
- Local debridement of dead bone
- NO excision as in osteoradionecrosis
