Jaw osteomyelitis – acute and chronic. Definition. Classification, epidemiology, etiology, pathogenesis.Traumatic osteomyelitis. Basic principles of treatment.

Question 1

Osteomyelitis definition

Answer 1

• Infection in bone marrow
• More common in mandible due to less profuse blood supply and cortical plate density
• Odontogenic infection cause

Question 2

Clinical presentation of osteomyelitis

Answer 2

• Deep pain
• Edema
• Associated teeth tender to percussion and may be loose
• Regional lymphadenitis
• Altered sensation in lower lip(IAN)
• Thrombosis of vessels→ Necrosis of bone

Question 3

Types of Osteomyelitis

Answer 3

• Acute
• Subacute
• Chronic

Question 4

Acute Osteomyelitis

Answer 4

• Radiographic changes after two weeks→ radiolucency in trabecular bone
• Periostitis

Question 5

Predisposing factors of Chronic Osteomyelitis

Answer 5

• HIV
• Diabetes
• Acute leukaemia
• Damage to jaw bones secondary to→ Radiation, osteosclerosis or trauma

Question 6

Chronic osteomyelitis

Answer 6

• Pain
• Induration of tissues
• Distention of periosteum w/ pus or inflammatory exudate→ Trismus and difficulty swallowing
• Tender enlarged lymph nodes
• Pathological fracture may develop

Question 7

Radiographic appearance of Chronic osteomyelitis

Answer 7

• Mottled appearance of bone
• Sequestrated necrotic bone

Involucrum →Subperiosteal new bone beside diseased area

Question 8

Management of Osteomyelitis

Answer 8

• Culture and sensitivity testing→ Antibiotic therapy
• Drainage and debridement
• Removal of infection source
• Resection and reconstruction of affected bone

Question 9

Chronic sclerosing non-suppurative osteomyelitis

Answer 9

• Sub and periosteal deposition of bone in response to dental infection of low virulence
• Young individuals
• Inferior border of mandible→ Nodular, firm swelling
• Onion skin appearance radiographically→ due to many layers of bone

Question 10

Treatment of Chronic sclerosing non-suppurative osteomyelitis

Answer 10

• Corticotomy
• Antimicrobial therapy
• Steroid therapy

Question 11

Diffuse sclerosing osteomyelitis of
the mandible

Answer 11

• Unknown cause
• Occur at any age but rarely in children
• Recurrent pain
• Variable radiographically→ Rarefaction and sclerosis

Question 12

Osteoradionecrosis

Answer 12

• Bone necrosis following radiation therapy→ Secondary infection
• Reduces vascularity of bone→ more prone to infection

Question 13

Osteonecrosis secondary to
bisphosphonate therapy

Answer 13

• Bisphosphonates reduce pain and bone destruction→ Inhibit osteoclast activity
• May cause osteonecrosis of jaws→ Reduced vascularity and inhibited osteoclastic activity

Question 14

Traumatic Osteomyelitis

Answer 14

• Observed in fractures of jaws
• Acute and chronic

Question 15

Acute Traumatic Osteomyelitis

Answer 15

• Soft tissue edema
• Pain
• Pus from fracture
• Lymphadenitis and abscess formation

Question 16

Chronic Traumatic Osteomyelitis

Answer 16

• Purulent fistulas
• Bone sequestrum
• Granulation tissue around necrotic lesion