DISORDERS OF MAXILLA AND

MANDIBLE

DR.SHAHZADI TAYYABA HASHMI

DNT 243

DISORDERS OF MAXILLA AND MANDIBLE

MAJOR INFECTIONS OF

JAWS

CYSTS OF JAWS

ODONTOGENIC and NON-

ODONTOGENIC TUMOURS OF

JAWS

MAJOR INFECTIONS OF JAWS

OSTEOMYELITISDefinition: An inflammatory process

within medullary ( trabecular) bone that involves the marrow spaces

Osteomyelitis of jaws is mainly a disease of adults with several potential sources of infection.

TYPES OF OSTEOMYELITIS

ACUTE OSTEOMYELITIS

CHRONIC OSTEOMYELITIS

GARRE OSTEOMYELITIS

ACUTE OSTEOMYELITIS

DEFINITIONA rapidly destructive inflammatory

process within bone that consist of Granulation tissue, Purulent exudate and islands of non-vital bone

(sequestra)

CAUSES OF ACUTE OSTEOMYELITIS

1. Caused by direct extension of untreated periapical abcess

2. Minor traumatic incident involving a mandible that has its blood supply compromised by previous high doses of radiation for the treatment of malignancy( OSTEORADIONECROSIS)

CLINICAL FEATURES OF ACUTE OSTEOMYELITIS

Commonly affects males with infection of mandible

Early complaints are Severe, Throbbing pain and swelling with external swelling due to inflammatory edema

Later distension of periosteum with pus occurs Finally, subperiosteal bone formation causes the

swelling to become firm Associated teeth are tender and mobile Overlying gingiva is red, swollen and tender Paresthesia of lower lip of affected side Regional lymph nodes are enlarged and tender Difficulty in mouth opening and swallowing

PATHOLOGY

At boundaries between infected and healthy tissues, OSTEOCLASTS RESORBS the periphery of dead bone and become separated as SEQUESTRUM( island of

dead bone)

Pus formed by inflammatory cells, reaches the SUBPERIOSTEAL region by RESORPTION of bone

Dead bone is recognized microscopically by lacunae, empty of OSTEOCYTES but filled with NEUTROPHILS and colonies of bacteria which proliferate in the

dead tissue

Thrombosis and obstruction leads to future bone necrosis

Infection causes acute inflammation in the MEDULLARY soft tissues and inflammation EXUDATE spreads infection through marrow spaces . It also

compress blood vessels

Mandible has a relatively limited blood supply and dense bone with thick cortical plate (so pus cant drain out)

Staphylococci may also cause infection when they enter from the skin through open fracture

Oral bacteria particularly anaerobes such as BACTEROIDES, PORPHROMONAS or PREVOTELLA species are important causes

RADIOGRAPHIC FEATURES OF OSTEOMYELITIS

Loss of trabecular pattern and areas of radiolucency indicates bone destruction

Ill-defined margins with fluffy and moth-eaten appearance

Areas of dead bone appears as dense areas

TREATMENT: Surgical treatment to establish drainage of purulent exudates Use of antibiotics to kill the microorganisms involved

RADIOGRAPHIC FEATURES AND TREATMENT

Radiographic features: Radiographic features are variable

but sometimes distinctive Sequestra will usually separate

spontaneously

TREATMENT: Antibiotics

CHRONIC OSTEOMYELITIS

Persistent low grade infection associated with bone destruction and Granulation tissue formation with little suppuration

CLINICAL FEATURES:Persistent ache / pain with exposed

bone

GARRE OSTEOMYELITIS

It is an unusual hyperplasic reaction of the periosteum to a chronic osteomyelitis of the posterior mandible that is unique to young patients.

CLINICAL FEATURES: Most frequently associated with advanced

acute caries in young patients Occurs when free gingival margin remain

above the height of contour of tooth results in food impaction

RADIOGRAPHIC APPEARANCE AND TREATMENT

Radiographic appearance: onion skin appearance

TREATMENT: Identification of source of infection Extraction of the tooth involved in infection Surgical treatment of tissues in molar

area

THANK YOU FOR YOUR ATTENTION