Chronic Suppurative Osteomyelitis: Causes and Characteristics
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Questions and Answers

What is the primary difference between osteitis and osteomyelitis?

  • Osteitis is a chronic condition, while osteomyelitis is acute
  • Osteitis is a localized condition, while osteomyelitis is a systemic disease
  • Osteitis is caused by bacterial infections, while osteomyelitis is caused by viral infections
  • Osteitis affects only bone, while osteomyelitis affects both bone and bone marrow (correct)

    • Which of the following is NOT a common cause of osteomyelitis?

  • Viral infection (correct)
  • Radiation therapy
  • Extension of periapical abscess
  • Bacteremia

    • What is the typical radiographic appearance of acute suppurative osteomyelitis?

  • A large, expansile cystic lesion
  • A well-defined, radiopaque lesion
  • A small, round radiolucency
  • A diffuse, ill-defined lytic radiolucency (correct)

    • Which of the following is a common symptom of acute suppurative osteomyelitis?

    <p>Paresthesia of the lower lip</p> Signup and view all the answers

    What is the typical histological feature of acute suppurative osteomyelitis?

    <p>Necrotic bone within a purulent exudate</p> Signup and view all the answers

    Which of the following bacteria is commonly cultured from acute osteomyelitis?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    What is the effect of radiation therapy on bone?

    <p>It decreases vascularity and leads to osteoradionecrosis</p> Signup and view all the answers

    What is the factor that predisposes patients to osteomyelitis?

    <p>Chronic systemic diseases</p> Signup and view all the answers

    What is the primary mechanism leading to chronic suppurative osteomyelitis?

    <p>The formation of a dense scar to wall-off the infected area</p> Signup and view all the answers

    Which region of the jaw is most commonly affected by chronic suppurative osteomyelitis?

    <p>Mandibular molar region</p> Signup and view all the answers

    What is the characteristic radiographic appearance of chronic suppurative osteomyelitis?

    <p>Mottled (moth-eaten) appearance with patchy ill-defined radiolucency</p> Signup and view all the answers

    What is the histopathological characteristic of soft tissue in chronic suppurative osteomyelitis?

    <p>Infiltrated chronic or mixed inflammatory cells</p> Signup and view all the answers

    What is the term for the focal bone reaction to a low-grade inflammatory stimulus?

    <p>Focal sclerosing osteomyelitis</p> Signup and view all the answers

    What is the typical age range for focal sclerosing osteomyelitis?

    <p>Children and young adults</p> Signup and view all the answers

    What is the characteristic clinical presentation of chronic suppurative osteomyelitis?

    <p>Painful jaw swelling with sinus formation, purulent discharge, and sequestra exfoliation</p> Signup and view all the answers

    What is the term for the new bone formation around sequestra in advanced chronic suppurative osteomyelitis?

    <p>Invulcrum</p> Signup and view all the answers

    What is the primary cause of periapical inflammatory lesions and osteomyelitis?

    <p>Bacterial cells or their toxins, or necrotic debris reaching the apical region</p> Signup and view all the answers

    What is the result of prolonged apical hyperemia?

    <p>Bone resorption</p> Signup and view all the answers

    What is the characteristic of apical hyperemia?

    <p>Dilatation of apical vascular bed and fluid escape</p> Signup and view all the answers

    What occurs if the irritation is not removed in apical hyperemia?

    <p>Bone resorption</p> Signup and view all the answers

    What is the characteristic of acute apical periodontitis?

    <p>Infiltration of PMNLs, dilated vessels, life and dead RBCs, and macrophages</p> Signup and view all the answers

    What is the radiographic finding in the first week of apical hyperemia?

    <p>No radiographic changes</p> Signup and view all the answers

    What is the clinical feature of acute apical periodontitis?

    <p>Severe pain on slight touch that is relieved by strong pressure</p> Signup and view all the answers

    What is the progression of periapical inflammatory lesions?

    <p>Apical hyperemia, acute apical periodontitis, chronic apical periodontitis, apical granuloma, osteomyelitis</p> Signup and view all the answers

    Study Notes

    Osteomyelitis

    • Inflammation of bone and bone marrow, while osteitis means inflammation of bone only
    • Results from:
      • Extension of periapical abscess
      • Physical injury (fracture or surgery)
      • Bacteremia
      • Non-bacterial osteomyelitis secondary to radiation therapy or low-grade chronic irritation
      • Chronic systemic diseases, immunocompromised states, or decreased vascularity

    Acute Suppurative Osteomyelitis

    • Clinically:
      • Fever (pyrexia)
      • Leukocytosis
      • Lymphadenopathy
      • Soft tissue swelling of the affected area
      • Drainage, with or without exfoliation of necrotic bone fragments (sequestrum)
      • Paresthesia of the lower lip, in case of mandibular bone involvement
    • Radiographic appearance:
      • Diffuse ill-defined lytic radiolucency
      • Individual trabeculae become fuzzy and indistinct, giving a moth-eaten appearance
    • Histologically:
      • Necrotic bone (sequestrum) is seen within a purulent exudate, occupying the marrow spaces
      • The necrotic bone shows loss of osteoblasts and osteocytes, with peripheral resorption (osteoclastic activity) and bacterial colonization

    Chronic Suppurative Osteomyelitis

    • Develops from unresolved acute osteomyelitis or as a chronic reaction due to long-term, low-grade inflammatory reaction
    • Mandibular molar region mostly affected, due to more diffuse blood supply and possibly early involvement of lower molars with caries
    • Clinically:
      • Painful jaw swelling
      • Sinus formation
      • Purulent discharge with sequestra exfoliation
      • Tooth loss or pathologic fracture
    • Radiographically:
      • Mottled (moth-eaten) appearance, of patchy ill-defined radiolucency
      • Focal opacities representing sequestra
      • The cortical plate may reveal osteogenic periosteal hyperplasia
    • Histopathology:
      • Soft tissue consists of infiltrated chronic or mixed inflammatory to the connective fibrous tissue, filling the inter-trabecular area
      • Scattered sequestra and pockets of abscess formation are common, with lymphocytes, plasma cells, and macrophages

    Focal Sclerosing Osteomyelitis (Condensing Osteitis or Bony Scar)

    • Means focal bone reaction to a low-grade inflammatory stimulus
    • An area of bone sclerosis associated with the apices of non-vital teeth with large carious lesions (usually lower premolar/molar area)
    • Mostly in children or young adults
    • Hypercementosis (low-grade irritation) and inflammatory radicular cyst formation

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    Description

    This quiz covers the definition, causes, and characteristics of chronic suppurative osteomyelitis, a complication of unresolved acute osteomyelitis or long-term low-grade inflammation. Learn about the clinical presentation and affected areas, particularly the mandibular molar region.

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