Osteomyelitis Overview Quiz

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Questions and Answers

What is the initial radiographic appearance of acute suppurative osteomyelitis?

Localized hyperdensity

Well-defined radiopaque area

Diffuse ill-defined radiolucency (correct)

Mottled appearance with central radiopaque sequestra

What histological feature characterizes necrotic bone in acute suppurative osteomyelitis?

Presence of giant cells

Formation of new bone tissue

High density of collagen fibers

Loss of osteocytes from lacunae (correct)

Chronic suppurative osteomyelitis is associated with which of the following features?

Absence of inflammatory cells

Granulation tissue and dense scar tissue formation (correct)

Rapid bone necrosis

Essentially normal appearing radiography

What radiographic appearance is typical of chronic suppurative osteomyelitis?

Mottled or moth-eaten appearance with patchy ill-defined radiolucency Signup and view all the answers

Focal sclerosing osteomyelitis is most commonly associated with which condition?

Non-vital teeth with large carious lesions Signup and view all the answers

What is the most common causative organism of acute suppurative osteomyelitis?

Staphylococcus aureus Signup and view all the answers

Which of the following is a predisposing factor for osteomyelitis?

Decreased immunity due to corticosteroids Signup and view all the answers

What does the term 'sequestum' refer to in osteomyelitis?

Fragment of necrotic bone that separates from vital bone Signup and view all the answers

What is a common clinical presentation of a patient with acute suppurative osteomyelitis?

Soft tissue swelling and fever Signup and view all the answers

Which type of osteomyelitis is characterized by healing or regenerating processes?

Chronic sclerosing Signup and view all the answers

Which condition is NOT a known etiology of osteomyelitis?

Obstructive sleep apnea Signup and view all the answers

In osteomyelitis, what results from the inflammation and pressure of pus in the medullary bone?

Thrombosis of arteries Signup and view all the answers

What is 'Garre’s osteomyelitis' characterized by?

Proliferative periostitis combined with chronic osteomyelitis Signup and view all the answers

Study Notes

Osteomyelitis

Osteomyelitis is inflammation of bone and bone marrow caused by bacterial infection.
It can be acute or chronic.
Osteon = bone
Muelinos = bone marrow
Itis = inflammation

Etiology of Osteomyelitis

Abscess
Infected cyst
Dry socket
Forceful extraction
Compound fracture of the jaw
Maxillofacial injury
Radiation
Uncontrolled diabetes
Malnutrition

Types of Osteomyelitis

Suppurative (destructive):
- Acute
- Chronic
Sclerosing (healing or regenerating):
- Focal
- Diffuse
Garre's osteomyelitis (Chronic osteomyelitis with proliferative periostitis)

Predisposing Factors

Chronic systemic diseases (e.g., diabetes)
Decreased immunity (e.g., acquired immunodeficiency, leukemia, prolonged high-dose corticosteroids)
Disorders causing decreased bone vascularity (e.g., Paget's disease, osteopetrosis, sickle cell anemia, irradiation)

Acute Suppurative Osteomyelitis

Causative organisms:
- Staphylococcus aureus (most common)
- Streptococci and anaerobic bacteria (less common)
Clinical presentation:
- Fever
- Lymphadenopathy
- Swelling

Pathogenesis of Osteomyelitis

Microorganisms cause inflammation in the medullary bone, resulting in edema and exudation.
Pus under pressure causes thrombosis of arteries (e.g., inferior alveolar artery).
Decreased blood supply leads to necrosis.
Later, pus drains through sinuses in skin or mucosa.
Sequestra: fragment of necrotic bone separating from adjacent living bone, sometimes dislodged.
Involucrum: necrotic bone fragment that is surrounded by new bone.

Acute Suppurative Osteomyelitis (Radiographic and histological features)

Radiographically shows diffuse ill-defined radiolucency, usually observable in one to two weeks.
Histologically necrotic bone shows loss of osteocytes from lacunae, peripheral resorption, and bacterial colonization. The periphery of the bone and Haversian canals contain necrotic debris and an acute inflammatory infiltrate (polymorphonuclear leukocytes).

Chronic Suppurative Osteomyelitis

Defensive response leads to granulation tissue formation resulting in dense scar tissue.
Radiographically, a mottled (moth-eaten) appearance of patchy ill-defined radiolucency with central radiopaque sequestra.
U/M: Chronically inflamed fibrous connective tissue filling the intertrabecular spaces of bone, with scattered sequestra.

Focal Sclerosing Osteomyelitis (Condensing Osteitis/Bony Scar)

Focal bone reaction to low-grade inflammatory stimulus.
Associated with apices of non-vital teeth with large carious lesions (usually lower premolar/molar areas).
Mostly in children or young adults (<20 years) but can occur at any age.
Radiographically appears as a localized, uniform zone of increased radiodensity adjacent to the apex of a tooth with long-standing pulpitis, or as a uniformly opaque area with a radiolucent center.

Focal Sclerosing Osteomyelitis (Histological Features)

Dense sclerotic (compact) bone with few empty lacunae, a mosaic appearance representing bone resorption/deposition, or reversal lines.
Marrow replaced by connective tissue and a few chronic inflammatory cells.

Diffuse Sclerosing Osteomyelitis

Bone sclerosis directly caused by irritating stimuli.
Primarily in middle-aged black females.
May affect any age, sex, and jaw.
Possible causes are periodontitis or pericoronitis.
Can be multifocal or affect an entire quadrant.

Diffuse Sclerosing Osteomyelitis (Clinical and Radiographic Features)

Clinically asymptomatic but may become painful, swollen, and occasionally drain pus with acute exacerbation.
Radiographically ill-defined, mottled, and more radio-opaque than normal; patchy diffuse or nodular sclerosis (cotton-wool appearance), observable with florid cemento-osseous dysplasia, or Paget's disease of bone.

Diffuse Sclerosing Osteomyelitis (Histological Features)

Dense bone with reversal lines (mosaic or pagetoid bone appearance).
Marrow replaced with connective tissue and chronic inflammatory cells; more neutrophils during exacerbation.
Sclerosing and remodeling results in widely separated Haversian canals, with little marrow tissue.
Sequestra may be surrounded by vital bone (involucrum).

Garre's Osteomyelitis (Chronic Osteomyelitis with Proliferative Periostitis)

Periosteal reaction to inflammation, creating layers of reactive vital bone that run parallel to each other.
Occurs most commonly in children and young adults, affecting the premolar-molar area of the mandible.
Etiology: dental caries followed by periapical inflammation.

Garre's Osteomyelitis (Radiographic Features)

Occlusal films show radiopaque laminations (onion-skin appearance) of bone roughly parallel to each other, underlying the cortical surface.
Radiolucent separation exists between new bone and the original intact cortex.

Garre's Osteomyelitis (Histological Features)

Parallel rows of highly cellular and reactive woven bone (each trabecula perpendicular to the surface or interconnected in a meshwork pattern).
Osteoblastic and osteoclastic activities are apparent.
Fibroblastic tissue replaces marrow spaces, with scanty chronic inflammatory cells.

Dry Socket (Alveolar Osteitis)

Localized osteitis of lamina dura lining tooth socket.
Blood clot fails to form in socket. This causes foul odor without pus.
Etiological factors include traumatic extraction, infection before/during/after extraction, and excessive mouthwash/rinsing.

Dry Socket (Clinical and Site)

Clinically painful, dirty gray clot, exposed bony socket, foul odor.
Usually affects the mandible more than the maxilla.

Dry Socket (Complications)

Osteomyelitis is a possible complication.

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Description

Test your knowledge on acute and chronic osteomyelitis, including radiographic and histological characteristics. This quiz covers common causative organisms, clinical presentations, and complications associated with osteomyelitis. Ideal for students in medical or health sciences.