Acute Osteomyelitis of the Jaws

Acute Osteomyelitis of the Jaws

• The term "osteomyelitis" was introduced by Norard in 1834 and later defined by Lannelongue in 1879 as an infectious, purulent, and necrotic inflammatory process of the osseous tissue.
• Acute osteomyelitis is characterized by foci of purulent infiltration of the bone marrow, thrombosis, and purulent liquefaction of clots, hemorrhage, and osteo-myelonecrosis.
• Classification of osteomyelitis of the jaws:
  • Odontogenic: up to 90% of cases, mainly caused by caries
  • Traumatic: 7-8% of cases, including gunshot wounds
  • Specific: 0.9-1.5% of cases
  • Radial (radionecrosis): 0.3-0.5% of cases
• Clinical manifestations of acute osteomyelitis:
  • Sharp pain in the tooth, spreading to adjacent teeth
  • Tooth mobility and foul smell from the mouth
  • Symptoms of systemic intoxication
  • Tender swelling of soft tissues, difficulty opening the mouth
  • Dense, painful infiltrate enclosing the jaw body
• Diagnostics of acute odontogenic osteomyelitis:
  • Evaluating anamnesis, clinical signs, and additional methods of investigation
  • Laboratory tests: increased leukocyte number, elevated ESR, altered protein level, and changes in immunocompetent cells
  • Radiographic signs: not pronounced in the acute stage, but helpful in complicated cases
• Treatment of acute odontogenic osteomyelitis:
  • Elimination of local purulo-necrotic processes by exposure and drainage of foci
  • Decrease of intoxication degree with normalization of vital functions and organs
  • Extraction of the causative tooth
  • Adequate medication, physiotherapy, and complex measures
• Complications of acute purulent odontogenic osteomyelitis:
  • Purulent processes in perignathic soft tissues (phlegmons and abscesses)
  • Acute sepsis, toxic lesions of kidneys, liver, and heart
  • Metastatic purulent foci in remote regions (brain, mediastinum)
  • Postoperative scars

Chronic Osteomyelitis

• The clinical picture of chronic osteomyelitis is determined by the extent of bone lesion during the acute stage.
• Mechanism of development: impaired endo- and extraosseous blood circulation, necrotic tissues, osteoclasts forming new osseous tissue, and granulation development.
• Formation of fistulas, discharge of pus, and separation of necrotic areas of the bone (sequestra).
• Clinical manifestations:
  • Functioning fistula or scarred indrawn areas of the skin and mucosa
  • Discharge of pus through fistulas
  • Quaggy, hypertrophic bleeding granulations
• Diagnostics of chronic odontogenic osteomyelitis:
  • Radiography of different kinds (conventional radiographs, CT, and MRI)
  • Determination of extent and term of necrsequestrectomy radiographically
• Treatment of chronic odontogenic osteomyelitis:
  • Sequestrectomy (rarely used in oral surgery)
  • Determination of access, margins of excision of affected tissues, and tactics concerning granulations of the sequestral capsule
  • Usage of particular compositions to fill in bone defects and cavities resulting from the operation
• Complications of chronic osteomyelitis:
  • Systemic: anemia, renal amyloidosis, sepsis, malignization of chronic process, exacerbation of accompanying disorders
  • Local: depending on the form and extent of the lesion