Osteomyelitis

1. Dr V.RAMKUMAR
CONSULTANT DENTAL& FACIOMAXILLARY SURGEON
REG NO; 4118 TAMILNADU-INDIA(ASIA)

2. INTRODUCTION
 Osteomyelitis is an extensive inflammation of
a bone.
 Involves the cancellous portion, bone marrow,
cortex, and periosteum.
 Because of the benefit of antibiotic Therapy
osteomyelitis is -no longer a common, severe
infection producing serious systemic involvement.

3. CLASSIFICATION
Osteomyelitis may occur in several forms:
 Suppurative osteomyelitis
 Acute
 Chronic
 Nonsuppurative osteomyelitis
 Chronic sclerosing
• Focal
• Diffuse
 Garre’s Osteomyslitis
 Osteomyelitis accompanying systemic diseases

4. SUPPURATIVE OSTEOMYELITIS
Osteomyelitis In Infants (osteomyelltis neonaterum)
The microorganisms are believed to enter
wounds made during delivery when the finger is
inserted into the child's mouth and the mucosa
scratched or later through injuries of the mucosa
made by sucking an object.

5. Four- year – old child with acute osteomyelitis of the
mandible

6. Clinical Findings
 Ostemyelitis in infants may have a sudden
onset and run an acute course.
 Such cases are associated with a severe
constitutional reaction
 High fever
 Rapid pulse,
 Vomiting, delirium, and prostration.

7. In chronic course - slow onset, with slight
fever, and moderate pain.
The local signs are swelling of the face,
Edema of the eyelids,
 Subperiosteal abscesses that develop on
the alveolar mucosa and palate,
Sinustracts draining pus.
Treatment
Antibiotics should be given intravenously

8. Acute suppurative Ostsomyelitls
 Acute, osteomyelitis in adults Involves the
mandible more often than the maxilla.
 the various vulnerable parts of the jaw may
succumb, especially the alveolar process, the
angle of the jaw, the posterior part of the
ramus and the coronoid process.

9. Large sequestrum in a patient with extensive
osteomyelitis of the mandible

10. The onset of acute osteomyelitis is
accompanied by fever and chills, rapid
pulse and respiration, and sometimes
nausea and vomiting. Dehydration and
acidosis may accompany the toxemia, and
albuminuria is a frequent finding.

11. The white cell count may show an
appreciable leukocytosis.
In addition, there is a decided "shift to left.
Toxemia is indicated by the presence of
immature cells.

12. Acute osteomyelitis causing considerable bone
destruction and resulting in a radiolucent appearance
of the ramus

13. RADIOGRAPHIC FINDINGS
 Enlargement of the marrow spaces.
 Later the cortex becomes involved,
 Forms osteolytic channels
 Surround dead pieces of bone, or sequestrum.
 Larger radiolucent areas denote active destruction of
bone.

14. Treatment
 Complete bed rest,
 a high-protein and high caloric diet,
 Adequate multivitamins.
Dehydration - administration of intravenous
solutions.

15.  Blood transfusions when RBC count is low.
Analgesics for pain.
Antibiotic therapy.
Penicillin - immediate drug of choice.

16. Chronic Suppurative Osteomyelitis
Chronic osteomyelitis, results from infection
by subvirulent organisms.
The failure to drain the pus results in
accumulation of pus and
consequent elevation of
periosteum from the bone.
The subperiosteal blood vessels are
stretched, breaks resulting in ischemia.

17.  Due to ischemia, cortical bone becomes
devitalized
Such a devitalized piece of bone appears
sclerosed and becomes a foreign body known
as sequestrum.
 The mandibular premolar regions are
mostly involved.
This is due to the thrombosis of the inferior
dental vessels exerting its pressure on the
inferior dental canal.

18. Chronic osteomyelitis – large sequestrum

19. Clinical Features
 Similar to those of acute osteomyelitis.
 The pain is less severe
 The temperature is still elevated
Leukocytosis is only slightly greater
than normal.

20. Teeth may not be loose or sore, so that
mastication is at least possible.
Acute exacerbations of the chronic stage
may occur periodically.
 The suppuration may perforate the bone
to form a fistulous tract
This form should be treated on the same
principles as its acute counterpart.

21. Radiographic findings
The sequestrum often appears
radiopaque,
 separated by a zone of radiolucency, -
“moth eaten appearance”
A layer of subperiosteal new bone
formation – “involucrum”
 Appears as a linear laminated opacity,
parallel to the cortical surface.

22. Chronic osteomyelitis – Mandible – III molar Chronic osteomyelitis – Mandible – III molar
region region

23. Chronic osteomyelitis – Mandible (Ramus).

24. SEQUESTRUM

25. TREATMENT
 Emperical antibiotic therapy
 Sequestrectomy and curettage
 Saucerization – cleaning up the bone cavity
rendering the cavity broad.

26.  Partial or total removal of cortex – known as
decortiication
 Cavity is packed with iodoform or whitehead’s
varnish

27. NON SUPPURATIVE OSTEOMYELITIS
CHRONIC FOCAL SCLEROSING OSTEOMYELITIS
(Condensing Osteitis)
 Chronic focal scelrosing osteomyelitis is an unusual
reaction of bone to infection,
 Occurrs in instances of extremely high tissue
resistance
 In cases of a low – grade infection.

28. Clinical Features
 Exclusively in young persons
 before the age of 20 years.
 Tooth most commonly is the mandibular
first molar.
 Mild pain associated with an infected
pulp.

29. RADIOGRAPHIC FINDINGS
 Well – circumscribed radiopaque mass of
sclerotic bone
 surrounds and extends below the apex of
one or both roots
 The entire root outline is nearly always visible

30. Radiograph shows sclerotic sequestrum

31.  An important feature in distinguishing it from
the benign cementoblastoma
Radiopacity stands out in distinct contrast to
the trabeculation of the normal bone.
 This is basically a reaction of bone to a mild
bacterial infection.

32. TREATMENT
The tooth is treated endodontically or extracted.
 The sclerotic bone constituting the osteomyelitis
is not attached to the tooth.
Remains after the tooth is removed.

33. Chronic Diffuse sclerosing Osteomyelitis
Chronic diffuse sclerosing osteomyelitis is a
condition analogous to the focal form of the
disease.
 Represents a proliferative reaction of the bone.
 Entry for the infection is through diffuse
periodontal disease.

34. CLINICAL FEATURES
 May occur at any age
 Most common in older persons.
Especially in edentulous mandibular jaws or
edentulous areas
Presents no clinical indications of its presence

35. Exposure of the necrotic bone – Intraoral
view of exposed bone

36. An acute exacerbation of the dormant chronic
infection
 Spontaneous formation of a fistula opening
onto the mucosal surface to establish drainage
 vague pain
 bad taste in the mouth.

37. RADIOGRAPHIC FEATURES
 Diffuse sclerosis of bone.
 Radiopaque lesion may be extensive - bilateral
 The border between the sclerosis and the
normal bone is often indistinct.

38. TREATMENT
 Lesion is usually too extensive to be removed
surgically,
 Yet it frequently undergoes acute exacerbations
Antibiotic administration.

39. If a tooth is present in one of these sclerotic
areas and must be extracted the probability must
be recognized.

40. Garre's Osteomyelitis Of The Mandible
chronic osteomyelitis with proliferative periostitis,
Periostitis Ossificans
 Nonsuppurative process in which there is
 Peripheral sub periosteal bone deposition
 Caused by mild irritation and infection.

41.  Affects children and young adults
 Generally involves the mandible.
The infectious process localizes in the
periosteum

42. A patient, aged 10 years, with
Garre’s osteomyelitis of the
mandible

43.  Spreads only slightly into the interior of
the bone.
 Bony thickening is visible in the
radiograph.
 Garre’s osteomyelitis should be
distinguished from infantile cortical
hyperostosis, or Caffey's disease.

44.  Caffey believed this disease to be of
infectious origin
 Because of the accompanying high fever
 Elevated sedimentation rate.
The disease is selflimiting and eventually
regresses.

45. Radiograph shows extensive proliferation of
subperiosteal bone

46. TREATMENT
 Unusually removal of the infected tooth
 Curettage of the socket are curative.
Surgery should be done only if there is
obvious facial asymmetry after at least a 6-
month waiting period.

47. Osteomyelitis associated with systemic
diseases
 In addition to nonspecific forms of osteomyelitis,
there are several specific types that accompany
certain systemic diseases.
 They include tuberculosis, actinomycosis and
syphilis.

48. TREATMENT
 Generally, treatment involves management of
the systemic pathosis, as well as local forms
of therapy.
 Osteomyelitis of the mandible also has been
reported as a complication of sickle cell
anemia.