Maxiofacial inflammation_Odontogenic__disorders__ENT module

Maxillary nerve

1. General features of maxillofacial inflammation in
children. Acute and chronic osteomyelitis,
periostitis: classification, ethiology, pathogenesis,
diagnosis and treatment.
Anatoliy G. Gulyuk, MD
Odessa national universty
Oral surgery department

4. Children with severe odontogenic infections
are likely to experience serious general
complications such as sepsis, mediastenitis,
sinus thrombosis. children suffering from
odontogenic infections usually present signs
of teeth formation and eruption disorders,
etc.

5. Dentist and paediatrician should work as a
team and consider such points as age,
anatomic and physiologic conditions of a child
in general and maxillofacial conditions in
particular in order to determine the method of
diagnosis, treatment and rehabilitation.

9. Odontogenic periostitis of the
jaws – he inflammation of periosteum
of the jaws. Clinically it's acute (serous
and purulent) and chronic (simple and
hyperplastic)
Clinical picture depends on reactivity,
immunity, type of imflammation and its
location.

12. serous periostitis is not considered a
separate clinical form. Purulent periostitis
follows the serous state.
Clinically there is an impairment of general
condition of a child, weakness, fever 38°C,
sleeping and appetite disorders, headache.
patient complains about pain in specific
tooth that may spread on temporal or
auricular region. there is sweling of cheek.

13. Facial configuration is changed due to
surrounding tissue swelling. there is an
enlargement of regional lymph nodes,
painfullness to touch, impaired and painfull
mouth opening.

14. in oral cavity there is mucosa hyperhaemia
(redness), swelling of mucobuccal fold near the
causative toot, fluctuation. the tooht is usually
rotten, might be covered with dental filling,
changed in color. percussion is painful. There
are no radigraphic findings of surrounding jaw
bone exept the apical region of causative tooth.

15. There is an increase of white blood cells, shift to
the left. there are no signs in urine exept the
increase of protein and little leucocytes.

16. The treatment of acute periostitis is complex
and consists of surgical procedure and medical
treatment. The focus of inflammation ought to
be dissected for pus evacuation and drained.
teeth that cannot be treated in conservative way
are to be extracted. Permanent teeth with one
root should be preserved.

17. After surgery the following treatment is
administered: diet, bed-side care, abundant liquid
consuming, mouth rinsing with antiseptic herbs
(salvia, camomille, etc.). Supplementary drugs
should be indicated considering the child's
condition, age and additional pathologic condition.
Antibiotics should be given to children under 5
years of age in case of severe general condition.
Detoxication, desensibilization, symthomatic
treatment is essential. If the tooth is to be
preserved, it should be treated temporarily till the
healing occurs.

18. Within 1-2 days after surgery patients get
better, pain disappeares, the body
temperature settles. On the other hand the
disease can transform to acute odontogenic
osteomyelitis.

19. chronic odontogenic periostitis:
usually occurs in children of 9-13
years of age. It could be simple or
hyperplastic. in most cases it's
primarily chronic periosteum
inflammation.

20. Main complaints about jaw deformity
(thickness, enlargement), periodic pain.
Mandible is usually impacted.
Clinical picture: dense, painless thickness of a
jaw bone close to the impaired tooth.
Mucose membrane at remission is usually
cyanotic or intact, the tooth is destroyed or
covered with filling. Percussion is painless.

21. mandibular lymph nodes are enlarged,
swollen, dense, but painless. There is an
«onion» sign on X-ray - that is excessive bone
formation under the periosteum (lines of
osseous tissue, parallel to jaw margin or
cortical layer). there are also changes of
periapical bone of causative tooth. the
structure of the bone is normally intact.

22. Treatment: Temporary teeth and multiple-
rooted permanent teeth should be extracted.
the usual period of treatment is 10-14 days. It
includes antibacterial therapy and
hyposensibilization. Physiotherapy is
significant art of treatment (lidaza, Potassium
Iodidum electrophoresis, ultrasound, laser
therapy).
If the treatment fails the surgical procedure
considering bone remodeling and elimination
of excessive bone should be applied.

23. Osteomyelitis – purulent necrotic
inflammation of the bone, periosteum, and
surrounding soft tissues. It usually occurs in
case of immune system failure.

25. Osteomyelitis of the jaws could be
odontogenic, haematogenic, or traumatic.
Clinically: acute and chronic. In case of acute
inflammation the general condition is
compromised, severely impaired, with
significant intoxcation.

26. Skin is pale, weakness, apathy, fever above
38°C, vomiting, seizures, peptic disorders,
severe pain at the causative tooth region.

27. clinical picture: facial assymenty, regional
lymph nodes enlargement, with painful
palpation. Rendess and 2-sided swelling of
alveolar ridge mucosa, dental mobility,
painful percussion.
All children should be delivered to in-paitent
department of a hospital. the tooth must be
extracted following peristeotomy and
administration of usual medications.

28. Chronic odontogenic osteomyelitis
could be destructive, destructive-productive or
productive. the infection usually occurs in
children with compromised immunity, persisting
chronic infection, in patients with impaired
general conditions.
Besides, these factors also destributes to arisal of
chronic osteomyelitis: delayed appeal for aid,
false diagnosis, prolonged conservative
treatment, irrational medication administration,
preserving of causative tooth.

30. Dуstructive form often occurs in children of
younger group of age. There is a
decomposition of bone with necrotic
fragments formation (sequesters). The
permanent teeth germs are usually involved
which leads to their death.
Productive form is observed in patients of
older group of age and considered primarily
chronic condition with no previous acute
stage. Bone enlargement with «onion»
symptom.

32. It's characterized by cycles n clinical course
(exacerbation turns to remission).
General condition of children at remission is
satisfactory. there is a slight pain, swelling and
increased bone density on the impacted side of
a jaw.
In destructive form there are fistulas, with
purulent necrotic content. The teeth could be
mobile. Sequester formation.
the exacerbation is smilar to acute osteomyelitis.

35. Treatment is supposed to be provided at the
in-patient department.
At exacerbation stage: teeth extraction,
periosteotomy, sequestrectomy,
antibacterial therapy, desensibilization,
immune therapy, physiotherapy.
At remission: immune therapy, vitamin
therapy, despanserization.

36. Haematogenic osteomyelitis:
as acute (7-9 days) or chronic destructive;
in children under 2 years of age with supplementary
infection (otitis, ethmoiditis, umbilical sepsis, purulent
skin diseases)
is a compound of septic condition;
triger: trauma, cold, infection;
usual location: condylar process of mandible rame;
Symptoms: impaired general condition, vomiting, fever,
seizures, tachycardia, clinical picture of acute
osteomyelitis;
within 2 days the destruction of cortical bone occurs
with subperiosteal abscesses and phlegmons formation
with multiple fistulas;

37. Traumatic osteomyelitis is usually
result of fracture or exacerbation of
persisting chronic inflamation of the
jaws.

38. Lymphadenitis – regional lymph
nodes inflammation as a result of local
infection. the infection spreads through
the damaged facial skin, oral or nasal
mucosa, periodontal lesions.
Lymhadenitis could follow stomatitis,
tonsillitis, rhinitis, ocular or nasal
infections, pyodermia, general paediatric
infections. The occurence of lymphadenitis
is due to incomplete local tissue immunity,
immature lymph nodes and decrease of
their protective function.

39. Local symptoms: enlarged, dense, non-
connected with surrounding tissues node;
the skin above it is intact; in case of purulent
- extremely painful node, unmoving, the skin
is swollen, with tension, + fluctuation.
General condition is impaired, with apathy,
weakness, stubborness, intoxication.

40. Treatment:
elimination of cause;
at the in-patient department;
dissection of focus with following draining;
complex medical treatment (antibact., detox.,
etc);

41. that's all!