Osteomyelitis of the jaw

Question 1

What local factors can lead to osteomyelitis of the jaw?

Answer 1

• Trauma to bone
• Major blood supply disease
• Local infections
• Osteoporosis

Question 2

What systemic factors can lead to osteomyelitis of the jaw?

Answer 2

• Leukaemia
• Severe anaemia
• Malnutrition
• AIDS
• IV drug abuse
• Chronic alcoholism
• Autoimmune disease
• Diabetes mellitus

Question 3

At how many weeks does osteomyelitis change from acute to chronic?

Answer 3

4 weeks

Question 4

What is the aetiology of acute suppurative osteomyelitis?
What are the clinical features?

Answer 4

Aetiology:
- Medullary infection spreads through marrow spaces, thrombosis in vessels leading to extensive necrosis of bone
- Lacunae empty of osteocytes but filled with pus, proliferates in the dead tissue
- Suppurative inflammation extends through the cortical bone

CLINICAL FEATURES:
- Severe throbbing, deep-seated pain
- Swelling due to inflammatory oedema
- Tenderness
- Swelling of the periosteum
- Firm swelling

Question 5

What is the histological features of osteomyelitis?

Answer 5

• Loss of osteocytes from lacunae
• Peripheral resorption
• Bacterial colonisation
• Acute inflammatory infiltrate consisting of polymorphonuclear leukocytes

Question 6

What is the management of acute suppurative osteomyelitis?

Answer 6

CONSERVATIVE: antibiotic treatment, drainage, analgesics, debridement

RADICAL: sequestrectomy (removal of dead bone)

Question 7

How does acute suppurative osteomyelitis become chronic?

Answer 7

Inadequate treatment
- Infection in the medullary spaces spread and form granulation tissue
- Granulation tissue forms a calcific deposition
- Encircled dead space acts as a reservoir for bacteria

Question 8

What are the clinical features of chronic suppurative osteomyelitis?

Answer 8

• Swelling
• Pain
• Sinus formation
• Purulent discharge
• Sequestrum formation
• Tooth loss
• Paraesthesia
• Pathologic fracture

Question 9

What is the management of chronic suppurative osteomyelitis?

Answer 9

Small lesions: curettage, removal of necrotic bone

Extensive lesions: resection +- vascular reconstruction or bone graft

Question 10

What is chronic focal sclerosing osteomyelitis? Management?

Answer 10

Commonly seen:
o Children and young
o In mandible, premolar & molar regions
o Bone sclerosis is associated with non-vital or pulpitic tooth
o No expansion of the jaw
NON SUPPURATIVE

Management: elimination of the source of inflammation by extraction or endodontic treatment

Question 11

What is chronic diffuse sclerosing osteomyelitis? What is the management?

Answer 11

Clinical:
- Large area of sclerotic bone involving multiple teeth
- Arises exclusively in adult hood with no sex pre-dominance
- Primarily occurs in mandible
- No pain
- No swelling

Management: elimination of originating sources of inflammation via extraction or RCT. Resection +- reconstruction