Osteomyelitis Oral Surgery

8/3/2019 Osteomyelitis Oral Surgery

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OSTEOMYELITISOSTEOMYELITIS


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D EFD EF .: It may be defined as a inflammatory condition of bone that

begins as a infection of medullary cavity & haversion system &

extend to envolve the periosteum of affected area.

It may be develop in jaw as a result of odontogenic

infection from abscessed teeth or post surgical infection .

OSTEOMYELITISOSTEOMYELITIS


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PR EDIS P OSING FACTO R PR EDIS P OSING FACTO R

Condition affecting the Host resistance

1) Diabetes Mellitus

2) Tuberculosis

3) Sever anemia

4) Leukeamia

5) Agranulocytosis

6) Acute infectionsuch as -

A) Scarlet fever B) influenza7) Typhoiyd

8) Sickel cell anemia

9) Malnutrition

10) Chronic alcholism

Condition affecting the Jawvascularity

1) Metastasis from area of infectionsuch as another bony site & kidney

2) Radiation

3) Osteoporosis

4) Osteopetrosis

5) Fibrous dysplasia

6) Pheriphral vascular disease.


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ETIOLOGY

1) Odontogenic infection

Periodontal

Periapical

Pericoronal

2) Infection from infected dental cyst

3) Compound fracture of Jaw.

4) Traumatic injury

5) Middle ear infection & upper respiratory tract infection through haematogenous route.

6) Furuncle of chin by lymphtic route

7) Peritonsillar abscess


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P ATHOGENESIS1 ) Virulent Organasim get entry winto medullary cavity via many

routes.

2) Localization of infection (Most infection are localized by a pyogenicmembrane & soft tissue abscess wall).

3) Disorganization of pyogenic membrane by micro organism & bychronic movement of unreduced fracture of Jaw.

4) Due to chronic movement of unreduced fracture or disorganizationof pyogenic membrane there will be ischemia & this will introducing the bacteria & microbes deep into under lying cavity.

5) Accumulation of Pus & there will be increased pressure in Medullary cavity.

6) Pus travel through haversion & volkaman's canal & accumulationbeneath the periosteum & elevating it from cortex & there by

reducing the blood supply.


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7 . Reduced blood supply causes necrosis of bone.

8. Then pus penentrate the periosteum & mucosal & cuteneous fisttulaedevelop & thereby discharging the purulent pus.

9. Small section of necrotic bone may get completely lysed while large get

localized & get separated from the shell of new bone by bed of grannulation tissue. The dead bone is surrounded by the new viable bonethis is called involucrum.

10. Involucrum contain one or more holes on the surface pus find its way from these orifices.

11. Beside all this microganism precipitate the thrombi formation thesethrombi provided isolating barrier from the immune response & further proliferation of microbes :- Thrombi can cause systemic spread of infection


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Note:Necrosis of bone with superadded infection form baseline

pathogenisis of osteomyelitis.C/F M > F

Site: Occur in mandibular PM area because :

A) Removal of post'r Mondibular teeth causing moredamage to the bone.B) Mandible is less vascular Maxilla


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Note:Infentile osteomyelitis- Is more common in Maxillar because spread through

hamatogenous route & maxilla has more blood supply than Mandible.Microbiology :1) Staphyloccous areus2) Staphyloccous albus3) Haemolytic Streptococci

Gram Negative organism1) Klebsiella2) Pseudomonas3) Proteus4) E. coli C LAFFI C ATION:C LAFFI C ATION:- -

D epending upon the presence or absence of separation :1. Suppurative 2- Non Supprative

a) Chronic non suppurative

a)Accute suppurative osteomyelitis b) Focal Sclerosing Diffuse sclerosingb) Chronic Supprative osteomyelitis c) Radiation osteomyelitis

Primary Secondary d) Garre's sclerosing osteomyelitis


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c) Infentile osteomyelitis e) Osteomyelitis due to specificinfection

i) Actinomycosisii) Tuberculosis

iii) Syphilis

ACUTE SUPPURATIVE OSTEOMYELITIS:1. T his is sequele of periapical infection.2. Diffused spread of infection throughout the medullary cavity.

C/F

1) Early acute supprative osteomyelitis 2. Late acute suppurative osteomyelitis

S ym.:a) Rapid onset a) Deep intense pain

b) severe pain b) Maliasec) Parasthesia or anaesthesia of c) Fevermental nerve At this stage d) Regional lymphadenopathyprocess is intramedullary f) Soreness of involve teeth & teeththerefore swelling is absent become loose within 10-14 days.

d) Tooth is not mobile

e) fistulae are not present


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Sign : 1) Pus exudate around the gingival sulcuscutaneous fistulae present.

2) Firm cellulitis of cheek 3) Abscess formation

R /F 1) Multiple redioleuciences2) Saucer shaped destruction with irregular margin.


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HI STOPAT H OLOGY :-

Medullary space are filled with inflammatory exudates that may or may not contain the pus.Inflammatory cells are chiefly neutrophilic, polymorphonuclear leucocytes.Rarely -1) Lymphocytes

2) Plasma cells

C H R O N I C SUPPU R AT IVE OST E OMY E LI TS * It occurs without initial acute stage* Virulence is low grade.

Chronic osteomyelitis is persistant absecess of bone, characterized by complex inflammatory process including necrosis of mineralised tissue & marrow tissue.

1. Primary type 2- Secondary Types: It is secondaryS ym :- to incompletely treated acuteosteomyelitisa) Insidous onset b) Slow increase in Jaw size gradual a) Local Tenderness & swelling developc) development of sequestra over the bone in the area of abscess.

without fistula formation b) Development of sinus.


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Sign- a) Formation of fistulaeb) Indurations of soft tissue.

c) Pain & tendernessd) Regional lymphadenopathyHISTOPATHOLOGY :- 1. Chronically inflamed

2. reactive fibrous connective tissuefilling the intertrabecular space

R/F:-

Single of Multiple radio leuciences of variable size.Margins are irregularMoth eaten appearance

C. I NF A NTILE OSTEO M YELITISIt is rare type of osteomyelitis infant few weeks after birth.It usually involve the maxilla.

Route of infection:1) Haematogenous route2) Trauma - prenatal trauma of oral mucosa from obstetrician's finger.3) Infection- Infection from mucosal bulb use to clear the air way

immediate after birth

4) Infected nipple -


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C/F a) Fever b) Anoroxia

c) Dehyrationd) Occasionly - convulsion, vomiting

Sign : a) Rednessb) Edema of eyelid c) Intracanthal swelling d) Proptosise) Sinus will develop


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1) Multiple radioleuciencies2) Saucershaped destruction with irregular margin

CH RO NI C N O N SUPPU R ATIVE OSTEO M YELITISDiffused sclerosing Localise sclerosing* Reactive proliferation Cause:- often seen in dentolous jaw* Occurs due to low grade Condition occurs when the resistante of C/F at any ageF > M the alveolar bone is highS ite - S pecially in edentolous virulence of organism is low

Mandibular Condition is characterized by focalSym. area of sclerosis around.During the period of growth patient the roots of teethmay complain of pain & tenderness. Site :- Occurs around the root of Molars.Usually asmptomatic R/F :- W ell circumscribe radiopaque.Sign. Slight enlargement of jaw Apical Mass - root out line is alwayson the affected side. visible.R /F H istopathology :- Dense bonyT here is presence osteolytic & trabaculae with very little fibrous tissueosteonecrotic bone.

Margins -illdefined H is topatholo gy 1. Dense irregular trabuculaof the bone2. Bone shows mosaic pattern

3. Lymphocytes4. Plasma cell


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H istopathology :-Supra cortical & supraperiosteal mass.Composed xcof much reactive osteoid tissue.Lymphocyte & Plasma cell.

RADIATION OSTEOMYELITISIt is a n inf ect i o n o f irr ad i ate b o n e .

C/F :-Occur with triad .

T rauma

Radiation


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:- x Sex :- M > F Sym.:- Intense pain, fistulaR/F Osteolytic region & appearance of late forming sequestra

I N VE ST I GAT I O N F O R OST E OMY E LI T I S a) Gram's staining b) Culture & sensitivity c) W.B.C. count & complete hemogram

d) Radiographe) Blood Sugar f) Sincitgraphy

MANAGEMENT OF OSTEOMYELITIS :a. Inscision & Drianageb. Irrigation & Debriment of the necrotic area.c. Sequestromy d. Saucerizatione. Closed wound irrigation & suction -f. Decortication

g. Hyper baric oxygen

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Osteomyelitis Oral Surgery