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Osteomyelitis of jaws
1. Dr. Anushan Madhushanka..BDS, MD/OMFS, MFDRCSI
Senior Registrar in OMF Surgery
Colombo North Teaching Hospital Sri Lanka
2. Introduction
Definition
Inflammation of the bone marrow & cortical bone
& periosteum with a tendency to progression.
Nonprogressive inflammation of the bone
1. Dentoalveolar abscess
2. Dry socket
3. Osteitis in infected fractures.
3. Pre antibiotic era – Very common
Antibiotic era – Uncommon
Now – emerging due to AB resistance
Diagnostic & therapeutic Challenge - if occurs
Need – Multiple surgeries
Prolonged Rx
Carries Morbidity risk – loss of Jaw & teeth
9. Pus in Volkman,s & Haversean System
Further blood supply cutoff & cortical perforation
Subperiosteal pus collection
Necrosis of cortical bone & Sequestrum formation
Fistula formation
10. Microbiology
Aerobs – Streptococcus viridans, Pyogenes
Staphylococcus
Anaerobic bacteria - Bacteroides
Pseudomonas
Peptostreptococci
Others – Klebsiella , Proteus , E. Coli
Specific – M. tuberculosis, T. Pallidum
Therefore Mixed infection
12. Hudson’s classification of
OM
1. Acute osteomyelitis
a. Contiguous focus
b. Progressive
c. Hematogenous
2. Chronic osteomyelitis
a. Recurrent multifocal
b. Garre’s
c. Suppurative or nonsuppurative
d. Sclerosing
14. Clinical Presentation
Acute OM features
Local - Pain – severe pain
Swelling and erythema
Paresthesia of the ID nerve
Trismus
Adenopathy
Systemic –
Fever
Malaise
15. Clinical Presentation
Chronic OM
Dull pain/ No pain
Mild swelling & minimal inflammation
Fistula + Pus
Exposed bone
NO fever - typical
16. Investigations
1. Plain X- rays – OPG
Lateral oblique view of mandible
changes of OM sources disease predisposing
conditions
Moth eaten appearance +/- Sequestrum
25%- 50% Deminaralisation – Radiological evidence
Therefore – Early acute OM not visible in X-rays
17. 2. Computerized tomography (CT)
Become the standard
3D imaging
Early cortical erosion
Extent of the lesion
Bony sequestra
Pathologic fractures.
Requires 30 to 50%
demineralization for visibility
18. 3. Magnetic resonance imaging (MRI)
Assist in the early diagnosis-
loss of marrow signal before cortical erosion
Better than CT
evaluation of soft tissue - fistula
19. 4. Technetium 99
Sensitive to - increased bone turnover areas
Inflammation – Infection
Trauma
No differentiation of infection
addition of Gallium 67 / Indium 111
Contrast agent, Bind to WBC
Differentiate infection from Trauma
23. Conservative Rx
Bed rest
Hydration – IV fluids, Oral
Supportive Rx – Nutrition – High protein, Fat
Vitamin enriched
Antimicrobials
Analgesics
Blood transfusion – If low Hb, WBC
24. Antimicrobial Rx
First choice
IV Pnicillin G - 2mu/ 6 hr
O. oxycilline - 1g/ 6 hr
If symptoms improved within 3 days – convert to oral drugs
O. Penicilline 500mg/6hr
Cloxacilline 250mg / 6hr – 2/3 weeks
Second choice
O. Clindamycine 600mg/ 8 hr – 2/3 weeks
Third choice
O. Cefazolin 500 mg/ 8 hr
Fourth choice
O. Erythromycine 2g /6hr
Others – Ticarcilline, Vancomycine, Ciprofloxacine if not respond