OSTEOMYELITIS

OSTEOMYELITIS
DEF.:
DEF 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.

 PREDISPOSING
FACTOR
Condition affecting the Host Condition affecting the Jaw
resistance vascularity
1) Diabetes Mellitus 1) Metastasis from area of infection
such as another bony site &
2) Tuberculosis
kidney
3) Sever anemia
2) Radiation
4) Leukeamia
3) Osteoporosis
5) Agranulocytosis
4) Osteopetrosis
6) Acute infection- such as -
5) Fibrous dysplasia
A) Scarlet fever B) influenza
6) Pheriphral vascular disease.
7) Typhoiyd
8) Sickel cell anemia
9) Malnutrition
10) Chronic alcholism
 ETIOLOGY
Periodontal
1) Odontogenic infection 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
 PATHOGENESI
1) S
Virulent Organasim get entry winto medullary cavity via many routes.

2) Localization of infection (Most infection are localized by a pyogenic membrane &

soft tissue abscess wall).

3) Disorganization of pyogenic membrane by micro organism & by chronic movement

of unreduced fracture of Jaw.

4) Due to chronic movement of unreduced fracture or disorganization of 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 & accumulation beneath the
periosteum & elevating it from cortex & there by reducing the blood supply.
7. Reduced blood supply causes necrosis of bone.

8. Then pus penentrate the periosteum & mucosal & cuteneous fisttulae
develop & 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 bone
this 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 these

thrombi provided isolating barrier from the immune response & further
proliferation of microbes :- Thrombi can cause systemic spread of
infection
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 more
damage to the bone.
B) Mandible is less vascular Maxilla
Note:
Infentile osteomyelitis- Is more common in Maxillar because spread
through hamatogenous route & maxilla has more blood supply than
Mandible.
Microbiology :
1) Staphyloccous areus
2) Staphyloccous albus
3) Haemolytic Streptococci
Gram Negative organism
1) Klebsiella
2) Pseudomonas
3) Proteus
4) E. coli CLAFFICATION:-
Depending upon the presence or absence of separation :
1. Suppurative 2- Non Supprative

a) Chronic non suppurative

a)Accute suppurative osteomyelitis b) Focal Sclerosing

Diffuse sclerosing
b) Chronic Supprative osteomyelitis c) Radiation osteomyelitis
c) Infentile osteomyelitis e) Osteomyelitis due to
specific infection
i) Actinomycosis
ii) Tuberculosis
iii) Syphilis

ACUTE SUPPURATIVE OSTEOMYELITIS:

1. This 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
Sym.:
a) Rapid onset a) Deep intense pain
b) severe pain b) Maliase
c) Parasthesia or anaesthesia of c) Fever
mental nerve At this stage d) Regional lymphadenopathy
process is intramedullary f) Soreness of involve teeth &
teeth
therefore swelling is absent become loose within 10-14 days.
d) Tooth is not mobile
e) fistulae are not present
 Sign :
1) Pus exudate around the gingival sulcus
cutaneous fistulae present.
2) Firm cellulitis of cheek
3) Abscess formation
R/F
1) Multiple redioleuciences
2) Saucer shaped destruction with irregular margin.
HISTOPATHOLOGY:-

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

CHRONIC SUPPURATIVE OSTEOMYELITS

* 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 secondary

Sym:- to incompletely treated acuteosteomyelitis
a) Insidous onset
b) Slow increase in Jaw size gradual a) Local Tenderness & swelling develop
c) development of sequestra over the bone in the area of
abscess.
without fistula formation b) Development of sinus.
Sign- a) Formation of fistulae
b) Indurations of soft tissue.
c) Pain & tenderness
d) Regional lymphadenopathy
HISTOPATHOLOGY :- 1. Chronically inflamed
2. reactive fibrous connective tissue
filling the intertrabecular space
R/F:-
Single of Multiple radio leuciences of variable size.
Margins are irregular
Moth eaten appearance
C. INFANTILE OSTEOMYELITIS
It is rare type of osteomyelitis infant few weeks after birth.
It usually involve the maxilla.
Route of infection:
1) Haematogenous route
2) 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 -
C/F a) Fever
b) Anoroxia
c) Dehyration
d) Occasionly - convulsion, vomiting
Sign: a) Redness
b) Edema of eyelid
c) Intracanthal swelling
d) Proptosis
e) Sinus will develop
Diffused 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
high
Site - Specially in edentolous virulence of organism
is low
Mandibular Condition is
characterized by focal
Sym. area of sclerosis around.
During the period of growth patient the roots of teeth
may complain of pain & tenderness. Site:- Occurs around the root of Molars.
Usually asmptomatic R/F :-Well circumscribe
radiopaque.
Sign. Slight enlargement of jaw Apical Mass - root out line is always
on the affected side. visible.
R/F Histopathology :- Dense bony
There is presence osteolytic & trabaculae with very little fibrous
tissue
osteonecrotic bone.
Margins -illdefined
Histopathology
1. Dense irregular trabucula
 GARRE'S OSTEOMYELITIS
⇒ Describe by carl Garre in 1893.
⇒ Also K/a proliferalitives periostitis.
⇒ Characterise by formation of hard bony swelling at the periphery of the
jaw.
C/F :-
⇒ Age > 30 years.
⇒M>F
Site :-
⇒ Mostly involve the ant'r surface of tibia & femer.
⇒ Mandible > Maxilla.
Sign :-
⇒ Hyper pyrexia.
⇒ Leucocytosis
⇒ Lymphadenophy.
R/F :
⇒Onion skin apperance.
 RADIATION OSTEOMYELITIS
It is an infection of irradiate bone.
C/F :-
⇒ Occur with triad .

Trauma

Radiation
Osteomyelitis

Infection Radiation
Site :- Mandible > Maxilla
Sex :- M>F
Sym.:- Intense pain, fistula
R/F
Osteolytic region & appearance of late forming sequestra

INVESTIGATION FOR OSTEOMYELITIS

a) Gram's staining
b) Culture & sensitivity
c) W.B.C. count & complete hemogram
d) Radiograph
e) Blood Sugar
f) Sincitgraphy

MANAGEMENT OF OSTEOMYELITIS :
a. Inscision & Drianage
b. Irrigation & Debriment of the necrotic area.
c. Sequestromy
d. Saucerization
e. Closed wound irrigation & suction -
f. Decortication
g. Hyper baric oxygen