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CHIR IV > CHAP 3-INFECTIONS OF THE MAXILLARY BONES > Flashcards

CHAP 3-INFECTIONS OF THE MAXILLARY BONES Flashcards

1
Q

ALV E O L A R O S T E I T I S
SYMPTOMS

A
  • PAIN (irradiated to ear)
  • Abscence of the blood clot
  • Occurs between the first and fourth day
  • May last 1 - 2 weeks
  • Halitosis, malaise and anorexia
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2
Q

ALV E O L A R O S T E I T I S
Anatomoclinic forms

A

Dry Socket==>Empty socket + intense pain
Suppurative alveolar osteitis==>Remains of blood clot + pus, less pain.
Marginal alveolitis==>Intermediate situation between the two previous
Phlegmon-like==>Invasion of adjacent sockets

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3
Q

OSTEITIS

A

Circumscribed lesions with no
tendency to produce bone
sequestrum

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4
Q

OSTEOMYELITIS

A

Diffuse lesions with sequestrum
formation

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5
Q

OSTEOPERIOSTITIS
CLINICAL FORM

A

1)ACUTE (AXHAUSEN )
2)CHRONIC

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6
Q

OSTEITIS

A

1)ACUTE (suppurative)
2)CHRONIC ( sclerosing or condensing )

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7
Q

OSTEOMYELITIS

A

1)INFANTS
2)ACUTE
3)CHRONIC
4)GARRE’S

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8
Q

localisation
MAX-MAND

A

Max 1 MAND 10

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9
Q

Rarefaction Stage

A

Osteolytic (by decreasing Ph) and osteoclastic occurrences

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10
Q

Necrosis Stage

A

Etiologic agents: Vascular and compressive occurrences
and toxins.
Sequestrate formation

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11
Q

Condensation Stage

A

Condensing osteitis: reparative action
Periosteum condensing reaction forms “Involucrum”
around sequestrate
(foramina of Troja: small holes into).

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12
Q

ACUTE OSTEOPERIOSTITIS

A

Axhausen’s osteoperiostitis
1) Children ( mandible )
2) Etiology==>dental infections
3) Exudate that separates the periosteum from the bone
4) Lack of clinical and radiological correlation
5) Swelling , pain , fever ? , fistulae

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13
Q

CHRONIC OSTEOPERIOSTITIS

A

1) After acute forms (inadequate treatment)
2) Low virulent infections
3) Slight symptoms
4) DIAGNOSIS RADIOLOGY
(Onion layers)
5) Pseudotumoral or pseudosarcomatous
forms (when it’s strictly localized )

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14
Q

ACUTE OSTEITIS (SUPPURATIVE)

A

1) IN MAXILLA OR MANDIBLE
2) CIRCUMSCRIBED INFECTION
3) ETIOLOGY: GRANULOMAS PERICORONITIS
POST-EXTRACTION ALVEOLAR FRACTURES
4) SIGNS AND SYMPTOMS: LOCALISED SWELLING + INTENSE PAIN
5) Rx: SIMULATE CYSTS (lytic area well defined but no sclerosed in the boundary)
6) CORTICAL BONE OSTEITIS OF DECHAUME
(Secondary to localized mucosal or cutaneous processes that spread by contiguity)

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15
Q

CHRONIC OSTEITIS

A

▪ Sclerosing or condensing
▪ Stimulation of osteoblasts
▪ Few symptoms
▪ NEURALGIFORM PAIN (few cases)
▪ X rays CONDENSATIONS NEAR THE APEX
independent from radicular cement

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16
Q

ACUTE OSTEOMYELITIS

A

▪ Etiology odontogenic infection
▪ Pain, trismus, fever, asthenia.
▪ Swelling in the mandibular region
▪ Tooth mobility
▪ Vincent’s sign +
▪ Patients with systemic diseases,
malnutrition
▪ Rx LARGE SEQUESTRUM

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17
Q

Symptoms of Actue osteomyelitis

A

1-Initial phase
2-infection phase
3-Sequestrum phase
4-Recovery phase

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18
Q

1) INITIAL PHASE

A

Periodontitis (Enlarged tooth sensation)
Pericoronitis
Pain+Fever+Trismus : 2 or 3 days

19
Q

2) INFECTION PHASE

A

Increased pain
Increased Septic Fever
Swelling—> Trismus
Inferior Alveolar Nerve Compression : Vincent’s Sign
Mobility of the causing tooth and the adjacent ones
Mucosal and Cutaneous Fistulae

20
Q

3)Sequestrum phase

A

Not in First day , after some weeks
Duration:weeks, Mouths
No general signs
Trismus
Lower lip anesthesia
Edema and jaw deformation
Fistulae
Mobilization of teeth
X ray (3 weeks) Sequestrum
Slow and Irregular Evolution

21
Q

4) Recovery phase

A

Bone loss: Gradually Repaired
Deformed bone
Teeth: Stable Outside the Sequestrum
Consequences Retractile Scars
Periosteum is very important for the recovery

22
Q

CHRONIC OSTEOMIELITIS

A

▪ PRIMARY (Low virulence microorganism) OR
SECONDARY (poor antibiotic treatment)
▪ FEW SYMPTOMS ,only in exacerbations
▪ LARGE BONE SEQUESTRUM
▪ SUPPURATIVE OCCURRENCES
Rx =RADIOLUCENT AREAS AND SEQUESTRUM
=Around sequestrum: Foramina(Cloacae) of Troja

23
Q

Involucrum:

A

Bone cavity of newly formed bone structureless that
contains a sequestrum

24
Q

Foramina :

A

Perforations in bone segments, that release pus content from sequestrum or bone cavity around it(Involucrum

25
Q

GARRÉ’ S OSTEOMYELITIS

A
  • Slight irritation or infection
  • No suppuration
  • Focal gross thickening of the periosteum
  • Peripheral reactive bone formation
  • Exclusive process of the mandible
  • Young people
26
Q

TREATMENT OST

A
  1. Ant biotherapy (same as Odontogenic Inf. but LONG TERM:
    ==>3 to 6 months in OM;8-12 days in PO and O)<==
    2.Hyperbaric O2-therapy
    3.He-Ne Laser
  2. Surgical treatment
    * Remove risk factors
    * Eradicate the primary infection
    * Fight the etiological infectious agent
    * Facilitate drainage of the osteomyelitis focus
    * Repair the destructive effects of the process
27
Q

SURGICAL TREATMENT

A
  • Drainage
  • Debridement
  • Sequestrectomy
  • Decortication
  • Saucerization ( marsupialization)
  • Intralesional antibiotic
  • Resection
  • Bone remodulation ( insclerosing forms )
28
Q

ETIOLOGICAL FACTORS

A

1.- Radiation: > 60 Gy
2.- Localization: 30 - 40% in carcinomas of the floor of the mouth
3.- Anatomical region: Mandible > Maxilla
People with teeth 4 > 1 Edentulous
4.- Systemic alterations: Hyperthyroidism Diabetes,
Syphilis, Tbc, Arteriosclerosis …
5.- Trauma: mucosa-bone continuity

29
Q

OSTEORRADIONECROSIS
PROPHYLAXIS
- Pre-radiotherapy extractions

A

Anterior teeth > 7 days
Premolars > 10 days
Molars > 12 days
Impacted > 20 days

30
Q

OSTEORRADIONECROSIS
AFTER RADIOTHERAPY

A
  • Avoid extractions
  • Treatment of xerostomia/hyposalivation:
    sialagogues, lysozyme, or substitutes
  • Discontinuous antibiotic and antifungal
    administration
  • Radiological controls (OPG) every six months
  • Hyperbaric oxygen therapy or laser
31
Q

BISPHOSPHONATES-RELATED OSTEONECROSIS
(BRONJ) or Medication-Related ONJ

A

-Osteoporosis treatment (orally)
-To decrease bone fracture
-Paget disease
-Malign Hipercalcemias due to bone metastasis of lung, breast and prostate
cancers (IV)
-Multiple Mieloma

32
Q

ONJ TREATMENT

A

Depending on the patient’s clinical stage:
Stage 1:
CHX mouthwash 0,12% and analgesic treatment in case of pain. Surgical treatment is not recommended
Stage 2:
CHX, analgesic treatment and Atb (15 days – 2/ 3 months)
Stage 3:
CHX, analgesic treatment, Atb + Surgical treatment:
sequestrectomy or block resection

33
Q

ODONTOGENIC SINUSITIS
ETIOLOGY

A

1- Nasal causes (ENT)
2- Odontogenic Causes
3- Other causes

34
Q

ODONTOGENIC SINUSITIS

A

➢ Chronic periodontitis (granuloma)
Contiguity mechanism / continuity of sinus mucosa and antral teeth
Caries –> Necrosis –> Granuloma
➢ Acute suppurative apical periodontitis
Acute suppurative apical periodontitis–> Pus breaks into the maxillary
sinus–> EMPYEMA
➢ Odontogenic suppurative cellulitis – } drains into the maxillary
sinus
➢ Osteitis and osteomyelitis after extraction
➢ No antral teeth through a subperiosteal abscess
➢ Radicular and dentigerous cysts
— } They usually reject the sinus mucosa:
- Sinus mucosa adhesions to the capsule of the cyst
- Acute infections- Pus in sinus cavity–> EMPYEMA
➢ Periodontal diseases
➢ Iatrogenic causes (Currently 2º cause)

35
Q

ACUTE MAXILLARY SINUSITIS:
CLINICAL SYMPTOMS

A
  • Etiology: allergic, viral and bacterial. Uncommon odontogenic cause.
    Last 1 month
  • Pain, irradiation to the orbit, frontal, zygomatic and alveolar region.
    Headaches
  • Swelling of the infraorbital soft tissue
  • Catarrhal purulent secretion: 1º fluid —- 2º purulent
  • Rhinoscopy: edema and redness of the nasal turbinates
    mucopurulent secretions in the middle
    meatus
  • Cacosmia
  • Systemic involvement
  • If oroantral communication: mucosal prolapse
36
Q

CHRONIC SINUSITIS

A
  • More usual: odontogenic cause. Lasts 3 weeks
    to 3 months
  • Slight symptoms
  • Characteristic nasal syndrome: vasomotor rhinitis:
  • nasal itching and nasal obstruction of the affected side
    -paroxysmal sneezing producing watery rhinorrhea
  • If fistula:
  • Liquid reflux from the oral cavity
  • Oral polyps
  • If the immune status of the patients is good and there is not a
    rhinogenic component: the evolution is usually asymptomatic (casual
    diagnosis)
  • Irregular hyperplastic mucosa: sinus cavity occupation
37
Q

SINUS EMPYEMA

A
  • Purulent accumulation in the maxillary sinus
  • Obliterated ostium
  • Cessation of ciliary activity
  • Sinus pressure increases: ACUTE PAIN
  • Infraorbital and cheek edema
  • RX: fluid levels. They change with head movements
38
Q

ODONTOGENIC SINUSITIS
TREATMENT

A

Intranasal antrostomy with endoscopic surgery
- Surgical creation of a drainage opening in the sinus
- Removal of hyperplastic mucosa, foreign bodies…
- Facilitates washings
- Samples for culture can be taken
Caldwell-Luc
- In chronic maxillary sinusitis with irreversible lesions
- Wide opening of the anterolateral wall of the sinus
- Excision, curettage of the mucosa

39
Q

OROANTRAL COMMUNICATIONS

A
  • Lack of continuity between oral cavity and
    maxillary sinus.
  • 3 planes affected:
    – Sinus mucosa
    – Maxillary bone and/or palate bone
    – Oral mucosa
  • Canal covered by epithelium
40
Q

ETIOLOGY

A

1)Proximity of the apex
2)Sinus pathologies causing communications
3)Iatrogenic cause
4)Infectious cause

41
Q

TREATMENT

A
  • First: resolution of the maxillary sinusitis. If it is not
    treated the perforation will recur
    ▪ - Consists of two phases:
    ▪ 1- Maxillary sinus intervention
    ▪ 2- Closure of oroantral communication
42
Q

1- Maxillary sinus intervention

A

a- Caldwell Luc approach
– Indicated in chronic sinusitis, polyps, cysts, mucoceles,
communications and trauma
b- Cleaning with imaging techniques: sinuscope
A micro camera is introduced in the nasoantral meatus and throught an
antrostomy of the anterior wall the diseased sinus mucosa is removed.

43
Q

A- Caldwell Luc approach

A

Removal of diseased sinus mucosa, providing ventilation of the antrum
that makes the reepithelialization easier
1-Incision
2-Flap reflection
3-Osteotomy
4-Removal of the sinus mucosa
5-Nasoantral perforation
6-Nasoantral drainage
7-Suture

CHIR IV (5 decks)

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