Professional Documents
Culture Documents
Jaws
DEFINITION
HISTORY
CLASSIFICATION
Reference
Classification
Classification
criteria
Hudson JW
Osteomyelitis of the jaws: a 50year
perspective.
J Oral Maxillofac Surg 1993 Dec;
51(12):1294-301
C. Suppurative or nonsuppurative
1. Inadequately treated forms
2. Systemically compromised
forms
3. Refractory forms (chronic
recurrent
multifocal osteomyelitis
CROM)
D. Diffuse sclerosing
1. Fastidious microorganisms
2. Compromised host/pathogen
interface
Reference
Classification
Classification
criteria
Topazian RG
Osteomyelitis of the Jaws. In
Topizan RG,
Goldberg MH (eds): Oral and
Maxillofacial
Infections.
Philadelphia, WB Saunders 1994,
Chapter 7, pp 251-88
I. Suppurative osteomyelitis
1. Acute suppurative osteomyelitis
2. Chronic suppurative
osteomyelitis
Primary chronic suppurative
osteomyelitis
Secondary chronic suppurative
osteomyelitis
3. Infantile osteomyelitis
II. Nonsuppurative osteomyelitis
1. Chronic sclerosing osteomyelitis
Focal sclerosing osteomyelitis
Diffuse sclerosing osteomyelitis
2. Garre's sclerosing osteomyelitis
3. Actinomycotic osteomyelitis
4. Radiation osteomyelitis and
necrosis
PREDISPOSING FACTORS
Fractures due to trauma and RTA
Gunshot wounds
Radiation damage
Paegets disease
Osteoporosis
Systemic disease
:Malnutrition,acute
leukemia,uncontrolled D.M.,Sickle
cell anemia,Chronic alcoholism
Osteomyelitis In Infants
(Osteomyelitis Maxillaris
Neonaturum)
Wilensky 1932
Hitchin & Naylor(1957)- 4 cases maxillitis of
infancy
Staphylococcus aureus
Injuries through foreign objects
Ramon et al 1977 infections from infants
nose
Haematogenous invasion streptococci
CLINICAL FINDINGS
Sudden onset ,acute course
High fever, rapid pulse, vomiting, delirium.
Signs Swelling of face,
Edema of eyelids
Subperioteal abscess
Sinus tracts draining pus
RADIOGRAPHIC FINDINGS
TREATMENT
ACUTE PYOGENIC
OSTEOMYELITIS
Localised or widespread
Debilitating systemic disease
ETIOLOGY
Odontogenic infections
Periapical disease
Periodontal disease
Pericororonal infection
Infection from odontogenic cyst or tumor
Infection from extraction wound
o Staphylococcus aureus, rarely albus
PATHOLOGY
RADIOGRAPHIC CONSIDERATIONS
Panoramic radiograph showing neither
abnormal consolidation nor ill-defined
trabecular bone structure around the
socket and clear running of the inferior
alveolar arteries.
Acute Osteomyelitis In
Children
Mandible or maxilla
Presence of unerupted tooth
Conservative treatment (antibiotics)
Condyle or TMJ Severe deformities (Rowe &
Heslop 1957)
Ord RA,el-Attar A.
Mandible> Maxilla
Sequestation of condyle rare Linsey 1953
Rbc and hb decreased
Leukocytosis
RADIOGRAPHIC FINDINGS
TREATMENT
OPERATIVE PROCEDURES
Immobilization-bartons bandage
Hot moist compresses localization of
infection
Surgical drainage
Extactions-offending tooth
Edentulous jaws
Incision along alveolar crest
Window is cut
Rubber dam inserted
Condylar pocess
Preauricular incision
Rubber drain
o
POST-OPERATIVE CARE
Continued use of
Antibiotics
External hot moist packs
Analgesics
Hot saline mouth rinses
CHRONIC SUPPURATIVE
OSTEOMYELITIS
Primary or secondary
Radiopaque bone dead sequestra attracts
calcium
Subperiosteal bone deposition
ETIOLOGY
TREATMENT
SEQUESTRECTOMY
Preoperative radiographs site of incision
Maxilla intraoral incisions
Mandible
1.Alveolar part intraoral incisions
Involved teeth removed
Intraoral wounds packed iodoform gauge
soaked in compound tincture of benzoin or
balsam of peru
SAUCERIZATION
SURGICAL COMPLICATIONS
Paresthesia of lip
Frature of weakened bone air drill with
sharp cutting instruments
Splints and fracture appliance
POST OPERATIVE
COMPLICATIONS
Septicaemia
Metastatic foci
Suppuration
Pathologic fracture
PATHOLOGIC FRACTURE
FIXATION METHODS
Maxillomandibular wiring-safest
1.Arch bars
2. Ivy wire loops
o Skeletal fixation
1.Pins and external bars
2. 2-3 weeks
3.Pins chronic cases
Constant recurrences
Disability & pain
Resection (kerley et al 1981)
INTRAORAL RESECTION
Incision from midline to high
on Ascending ramus
EXTRAORAL RESECTION
Mandilmandible
exposed ,neurovascular
bundle cut and tied
,osteotomies are made
with gigli saw ,air drill .
HYPERBARIC OXYGEN
Mainous 1975,Marx 1983
Pure oxygen greater alveolar
partial pressure
Elevation of oxygen tension
Improved vascular supply
& increased oxygen perfusion
Fibroblast proliferation ,
new capillary (Hunt et al 1975)
Osteogenesis (Maekley et al 1967)
Dry osteomyelitis
Localized or diffuse (Bell 1959 ,Shafer 1957)
Older people ,black women
Sclerotic opacities & lytic areas
Bone granite hard ,mandible
TREATMENT
GARRES OSTEOMYELITIS
Nonsuppurative process in which there is
peripheral sub-periosteal bone deposition
caused by infection and irritation.
Carles garre 1893
In mandible Pell et al (1955)
Children and young adults
Etiology carious tooth ,soft tissue infection
(Ellis ,Winslow 1977)
Radiograph
1.Condensation of cortical bone
2.Overgrowth of osseous tissue beneath periosteum
Differential Diagnosis
-Infantile cortical hyperstosis /Caffeys Disease
young infants ,no of bones,clavicle .
TREATMENT
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