Osteomyelitis Flashcards
Considerable factors affecting osteomyelitis
:
Bone
- Virulence of MO.
- Host resistance.
- Anatomic location.
- Patient age (extremities of age).
- Pre-existing systemic factor→ Paget’s disease of bone,
sickle cell anemia, and irradiation, osteopetrosis.
- Immunocompromised status → alcohol abuse, drug abuse, DM, AIDS, malnutrition, malignancy.
Changes on symptoms from acute to chronic osteomyelitis
- pain becomes variable
- no trismus
- there is still mild pyrexia
Pus - lymphadenopathy
- leukocytisis
- lip papathesia
- cyclic exacerbation
Commonality
Sequestrum
-if involved periosteum
..sinus and fistula
..swelling tenderness redness of skin and mucosa
..periodontitis and mobility
Chronic supp osteomyelitis xray
Ill defined
Mottled ro
Histology of acute osteomyelitis ?
- perulent exudate in marrow space
- increase osteoclastic activity
- cut of blood supply creates sequestrum which if long standing becomes involucrum
Histology of chronic osteomyelitis
- marrow ..vasodilation ..exudate and edema ..less purulent exudate ..necrosis of marrow ..fibrosis for repair .. chronic inflammatory cells - trabeculae ..involuctrum sequestrum .. osteoplastic and clastic .. reversal lines .. loss of osteocytes and osteoblasts ..
Ttt of chronic osteomyelitis
1- Selective antibiotic & pus drainage.
2- Sequestrectomy, surgical removal of sinus tract.
3-Hyperbaric oxygen in resistant cases which stimulate:
- Vascular proliferation.
ii. Collagen synthesis.
iii. Osteogenesis.
o Hyperbaric oxygen→ special room with 100% oxygen at 2 atmosphere 2h/day
for several weeks.
o Contraindicated in:
- Viral disease.
ii. Lung disease.
iii. Optic neuritis.
iv. Residual, recurrent malignancy.
Condensing ostitis response to rct
And marrow condition
- remain on xray even after extraction or rct
- fibrosis with chronic inflammatory cells
Chronic sclerosing osteomyelitis etiology
- inflammatory reaction to low virulence micro organism
Creating hypersensitivity reaction and is associated with chronic periodontitis
Diffuse S O clinical
-black females middle age
- vague pain
- if acute exacerbation
..pain
..swelling
.. pus formation
- positive microbiological culture
Diffuse S O xray
-ill defined ro
Bi
May involve 4 quadrants
Diffuse sclerosing osteomyelitis histology
- fibrosis and chronic inflammatory cells in marrow
- osteoclastic and blastic
Mosaic pattern of reversal lines
Ttt of diffuse sclerosing osteomyelitis
- pamidronate
- low dose corticosteroids
- decortication of affected area
- periodontitis treatment
- antibiotics with acute exacerbation
Etiology of garry’s osteomyelitis
Periosteal inflammation and proliferation with chronic osteomyelitis associated with periapical abscess or partially erupted molars or following tooth extraction
Clinical of garre’s
Asymptomatic or mild pain. 2. Unilateral bony hard swelling.
- Normal l appearance of overlying skin and
mucosa.
- Age → mainly in children.
- Site-lower molars, mainly 18 molar or
following extraction.
Xray of garre’s
Periapical film- radiolucent lesion
which is centrally mottled.
o in occlusal film- expanded cortex with
parallel opaque layers perpendicular to
R/F
cortex (onion skin appearance).
Histology of garre’s
peripherally-osteoblastic activity new subperiosteal and supracortical deposition of woven bone trabeculae perpendicular to
cortical bone Osteoblastic and osteoclastic activity is seen
H/P
Chronic inflammatory cells and fibrosis in
bone marrow.
Chronic tendoperiostitis
Chronic inflammation of periosteam & tendons of muscles. Inability to relax jaw muscles due to habits as bruxism, clenching, nail biting & psychogenic stress.
1-age mean age 40 years.
2-Swelling of check & recurrent pain.THT Pain
3-Trizmus.
4- Negative microbiologic culture → non
responsive to antibiotics.
1- Bone sclerosis (radio opaque area) anterior to mandibular
angle at attachment of masseter muscle.
2 Bone erosion at inferior border of mandible anterior to
mandibular angle.
C/P
1-Sclerosis, remodeling of cortical and subcortical bone at musc
attachment1 bone volume.
2- Inflammatory cells in resorbed areas.
Ttt ..analgesia and corticosteroids ..night guard .. intra oral decortication may be done ..
Precipitating factors of osteoradionecrosis
Add Surgery Scaling Periodontal disease Periapical abscess
Symptoms of osteoradionecrosis
-radiation induced mucositis
- radiation induced caries
- dry mouth
Sequestration
Histology of osteoradionecrosis
- sequestrum
- narrowing of blood vessel by fibrous tissue
- destruction of osteoblasts
- chronic inflammatory cells
Precautions for osteoradionecrosis
Any un restorable tooth should be extracted two weeks prior to radiation therapy
If radiation was less than 6500 rad could extract after radio by 1y with penicillin coverage for 5 to 7 d
Treated by hyperbaric o2 and antibiotics
Avoid o2 if there is residual tumor
