Osteomyelitis
Inflammation of the medullary component of the jawbone which spreads to involve the periosteium
Pathogeneis
- Odotogenic infection results in inflammation in the marrow spaces
- Inflammatory exudate spreads along the marrow spaces resulting in build up of pressure
- Build up of pressure results in thrombosis of blood vessels > depriving blood supply
- Ischaemia and necrosis of bone occur
- Liquefaction of necrotic tissue
- Lifting of periosteum due to further necrosis
- Osteoclastic activity then results in bone sequestreum
Mechanisms of infection
Odontogenic focus - caries > pulpal disease > periapical pathology
Trauma
Surgery
Spread from non-odontogenic infections
More likely to occur in MANDIBLE
maxilla has thin medullary bone and more vascular bone
Risk Factors
Local Risk Factors
Osteoporosis
Osteopetrosis
Paget's Disease
Radiotherapy
Bone Malignancy
Systemic Risk Factors
Diabetes
Malnutrition
Alcoholism
Sick Cell Anaemia
AIDS
Steroid use
Chemotherapy
Autoimmune disease
Acute Suppurative Osteomyletis
Chronic Suppurative Osteomyelitis
Garre's Osteomyeltis
Presentation
Treatment
Mimics a dental abecss
Pain
Swelling
Lymphadenopthy
Purulent exudate
anaesthesia/parathesia
fever
fistula formation
trismus
cellulitis
Hospitiliation to administer high dose anti-biotic therapy
Identify and treat the cause
Attempts at healing with granulation and new blood vessel formation
Predisposing Factors
Long term antibiotic use
Immunocompromised
Presentatiion
Pain
Swelling
Purulence
Non-healing socket
Intra-oral draining fistula
Management
Surgical Procedures
IV antibiotic therapy for 2 weeks or until signs of improvement for 48-72hrs
Oral antibiotic therapy for 4-6weeks after asymptomatic from date of last debridement
Drain and irrigate the area
removal of loose teeth and sequestra with resection and reconstruction where indictated
possible placement of irrigating drain/ PMMA antibiotic beads
Chronic osteomyelitis with new bone formation resulting from periosteal reaction to inflammatory/infectious stimulus
Imaging
Plain films - only show changes once bone resorbed
MRI
CT scan
Bone Scan