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4th yr- CMS- Bones, Skeleton and trauma > Osteomyelitis, osteonecrosis and Osteoradionecrosis > Flashcards

Osteomyelitis, osteonecrosis and Osteoradionecrosis Flashcards

1
Q

Give the pathological definition for osteomyelitis

A

Inflammation of bone marrow

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2
Q

What is osteomyelitis

A

A spectrum of inflammatory and reactive changes in the bone and periosteum

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3
Q

What can osteomyelitis result in

A

Due to the indicative disease of bone it can result in necrosis of the affected bone

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4
Q

Which area is almost always affected in osteomyelitis

A

in almost all cases the infection extends to involve the cortical bone and periosteum of the affected area.

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5
Q

Name the different types of osteomyelitis

A
  1. Acute
  2. Chronic
  3. Subperiosteal
  4. Sclerosing
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6
Q

What can acute and chronic osteomyelitis also be called

A

Suppurative and Non-suppurative

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7
Q

What is acute osteomyelitis

A

When a clinical picture of acute infection is seen

Systemic effects seen

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8
Q

What can chronic osteomyelitis be split into

A

Primary and secondary

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9
Q

What is primary chronic osteomyelitis

A

When there is no acute episode present

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10
Q

What is secondary chronic osteomyelitis

A

When a prolonged inflammatory process is seen

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11
Q

Talk through the aetiology of osteomyelitis

A
  1. Odontogenic infection
  2. Underlying disorders
  3. Infected cysts
  4. Infected tumour
  5. Surgical wounds
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12
Q

What are the risk factors fro osteomyelitis

A
  1. Fibrous dysplasia
  2. Previous radiation bone exposure
  3. Osteoporosis
  4. Osteopetrosis
  5. Paget’s disease
  6. Bone tumours
  7. Immunocompromised patients
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13
Q

Talk through how osteomyelitis can lead to bone necrosis

A
  1. Bacteria infects bone marrow space
  2. This increases vascular collapse, venous stasis and thrombosis and ischaemia
  3. This increases inter medullary pressure and compromises blood supply
  4. Necrosis of bone
  5. Sequestration of new bone and increased resorption
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14
Q

List some bacteria that can lead to osteomyelitis

A
  1. Bacteroides
  2. Anaerobic strep
  3. Staph
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15
Q

What can lacteal infection in marrow space lead to

A

Increased intramedullary pressure and compromised blood supply

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16
Q

Is the mandible or maxilla more susceptible to osteomyelitis

A

Mandible

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17
Q

Why is the mandible most sensitive to infection that the maxilla

A
  1. As mandible is cancellous bone which is more likely to become ischaemic
  2. Blood supply to mandible is less oxygenates than maxilla
  3. Dense ovelying cortical bone of mandible prevents penetration of periosteal blood vessels in comparison to maxilla
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18
Q

Describe the microbiology of osteomyelitis

A
  1. Viridans streptococcus
  2. Strict anaerobes
  3. Staph aureus
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19
Q

Name some strict anaerobes that can lead to osteomyelitis

A

prevotella,
fusobacterium,
peptostreptococcus

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20
Q

Describe the how osteomyelitis of the mandible may present

A
  1. Deep intense pain with high intermittent fever
  2. Identifiable causable tooth
  3. Patient may have malaise, headache and reduced appetite
  4. Minimal swelling
  5. No fistulae
  6. Infection usually well localised
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21
Q

How long does the initial event for mandibular osteomyelitis last

A

1-2 weeks

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22
Q

What can happen if osteomyelitis of the mandible is not treated

A

Can spread and more toxic symptoms can develop

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23
Q

Talk through the signs of mandibular osteomyelitis

A
  1. Purulent discharge eroding bone
  2. Puss
  3. Extensive firm swelling
  4. Possible trismus
  5. Throbbing jaw pain
  6. Severe tenderness
  7. Extrusion of teeth
  8. Nerve involvement
24
Q

Give some signs of mandible inflammation

A
  1. Leukocytosis
  2. Elevated CRP
  3. Local lymphadenopathy
25
Q

Talk through the presentation of chronic osteomyelitis

A
  1. Normothermic
  2. Symptoms resolve/ disappear
  3. Teeth locally are tender
  4. Sequestra maybe expelled through mucosa
26
Q

How do we diagnose acute osteomyelitis

A

Through clinical findings such as deep intense pain, paraesthesia etc

27
Q

How do we diagnose chronic osteomyelitis

A

Through clinical findings AND imaging

28
Q

When is osteomyelitis detectable on a plain film

A

1-2 weeks after onset

29
Q

What are the characteristic features of osteomyelitis

A
  1. Increased radiolucency
  2. Moth eaten island of bones
  3. sequestra
30
Q

What gives us a better imagine than plain oil,

A

CT scans and MRIS

31
Q

What will a CT/ MRI of osteomyelitis show

A
  1. Increased attenuation in medullary cavity
  2. Destruction of cortical bone
  3. Proliferation of bony tissue
  4. Sequetra
32
Q

How can we treat osteomyelitis

A
  1. Antibiotics
  2. Surgery
  3. Hyperbaric oxygen
33
Q

Which antibiotics do we prescribe for osteomyelitis

A
  1. High dose penicillin with or without Metronidazole

2. Clindamycin

34
Q

When might we prescribe penicillin for osteomyelitis treatment

A

When blood flow is compromised

35
Q

How does clindamycin help treat osteomyelitis

A

Penetrates vascular tissue

36
Q

What are the benefits of surgically treating osteomyelitis

A

Removes cause / eliminates source

Is important for micro sampling

37
Q

How can hyperbaric oxygen aid osteomyelitis treatment

A
  1. Increase in oxygen result sin augmentation of angiogenesis
  2. Improvement in osteogenesis
  3. Increase in leukocyte activity
  4. Stimulates growth factors
37
Q

How can hyperbaric oxygen aid osteomyelitis treatment

A
  1. Increase in oxygen result sin augmentation of angiogenesis
  2. Improvement in osteogenesis
  3. Increase in leukocyte activity
  4. Stimulates growth factors
38
Q

How is osteomyelitis different to alveolar osteitis

A

Osteomyelitis:

  1. Spreads through bone
  2. Is not self limiting
  3. Much more chronic
  4. Represents failure of normal defence
39
Q

Define Osteoradionecrosis

A

Bone necrosis in previously irradiated tissue in the absence of tumour persistent or recurrence

40
Q

Talk thorough how bone is necroses in Osteoradionecrosis

A
  1. Irradiation of bone leads to osteocytes and fibroblast death
  2. Bone is hypo-cellular as a result
  3. This reduced vitality and inability to prepare
  4. Trauma may occur
  5. Bone necrosis occurs
41
Q

What are the clinical features of Osteoradionecrosis

A
  1. Follows radiotherapy
  2. Exposed bone (often small asymptomatic site)
  3. Severe pain
  4. Oro facial fistulas
  5. Foul smelling necrosis of jaw
  6. Suppuration
  7. Pathological fracture
42
Q

How do we diagnose Osteoradionecrosis

A

Through signs and symptoms

Imagining

43
Q

What signs and symptoms do we see in Osteoradionecrosis

A
  1. Severe pain
  2. Non healing exposed bone
  3. Incidents of recurrent infection
44
Q

What does a plain radiograph of Osteoradionecrosis show

A

Reduced bone density and sometimes fracture

45
Q

What does MRONJ stand for

A

Medication Related Osteonecrosis of the Jaws

46
Q

Patients on what medication have a higher risk of developing MRONJ

A

Bisphosphonates

47
Q

What do Bisphosphonates do

A
  1. They attach to hydroxyapatite binding sites particularly on surfaces that are actively resorbing
  2. They impair osteoclastic ability to bind to the bony surface and inhibit resorption
  3. Reduces osteoclast activity by promoting osteoclast apoptosis and inhibiting development of new osteoclasts
48
Q

Why are Bisphosphonates prescribed

A
  1. Metastasising solid cancers
  2. Multiple myeloma
  3. Hypercalcaemia of malignancy
  4. Post menopausal osteoporosis
  5. Steroid induced osteoporosis
  6. Paget’s disease
49
Q

Define MRONJ

A

Exposed bone the can be proved through an intra oral or extra oral fistula in the maxillofacial region which has persisted more than 8 weeks in patients with a history of treatment on Bisphosphonates and where there has been no history of radiation therapy

50
Q

Describe the pathopsyiology of MRONJ

A
  1. Inhibition of osteoclastic bone resorption and re modelling
  2. Inflammation of infection
  3. Inhibition of angiogenesis
51
Q

Name some Bisphosphonates

A
  1. Alendronic acid
  2. Risedronate sodium
  3. Zoledronic acid
  4. Ibandronic acid
52
Q

Talk through how MRONJ develops

A
  1. Extraction or mucosal trauma preceded osteolytic lesion
  2. Patients develop exposed bone in the jaw
  3. Exposed bone may worsen or heal slowly
53
Q

Is MRONJ more common in the maxilla or mandible

A

Mandible

54
Q

What increases the risk of developing MRONJ

A
  1. Previous MRONJ diagnosis
  2. If patietn is on anti resorptive or anti angiogenic drugs
  3. If patient has been taking Bisphosphonates for more than 5 years
  4. If the patietn is being treated with systemic glucorticosteroid

4th yr- CMS- Bones, Skeleton and trauma (3 decks)

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