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

2. RECAP
- DEFINITION
- PERIOSTITIS/ OSTEITIS
- OSTEOMYELITIS
- Classification
- Etiology
- Microbiology
- Pathogenesis

3. Acute Osteomylitis –
Clinical features
Local
painful tooth (if Odontogenic )
Parasthesia of the lip (mandible )
Swelling in the effected area
Difficulty in mouth opening
General
raise In temperature
Rapid pulse & respiration
Nausea & vomiting
Dehydration,acidosis,albuminuria
leukocytosis

4. Radiographic Features
Enlargement of the marrow space
Sequestrum
(Dead bone surrounded by osteolytic
channels)
Involucrum
(Reactive bone formation)

5. SCINTIGRAPHY – BONE SCAN
IN EARLY DETECTION OF
OSTEOMYLITIS

6. CHRONIC OSTEOMYLITIS
CLINICAL FEATURE
PAIN IN THE EFFECTED TOOTH
SWELLING
SINUS DISCHARGE ( EXTRA ORAL )
LESS SYSTEMIC SYMPTOMS
DIFFICULTY IN MOUTH OPENING

7. RADIOLOGICAL FEATURE
CHRONIC OSTEOMYLITIS
MORE OF RADIO OPAQUE
OR
MIXED RADIO OPAQUE&RADIOLUCENT
(CLASSICAL MOTH - EATTEN APPEARANCE)

8. PROTOCOL OF MANAGEMENT
EMPERICAL ANTIBIOTIC
CONTROL OF TOXIC SYMPTOMS
INCISION & DRAINAGE
CULTURE & SENSITIVITY
APPROPRIATE ANTIBIOTICS
REMOVAL OF THE CAUSE
LATERAL TRIPHINATION
CURRETAGE
SEQUESTRECTOMY
SAUCERIZATION
DECORTICATION
SEGMENTAL RESSECTION
HBO

9. I & D ONLY IF IT IS FLUCTUENT
SEND FOR CULTURE AND SENSITIVITY

10. SAUCERIZATION
CREATES A UNIFORM BED
HELPS IN COMPLETE DRAINAGE
IMPROVE THE BLOOD SUPPLY

11. DECORTICATION
IMPROVES BLOOD SUPPLY TO THE
BONE

12. ANTIBIOTIC IRRIGATION

13. OSTEOMYLITIS IN CHILDREN
COMPLICATED BY
PRESENCE OF TOOTH GERM
IN CONDYLE MAY LEAD TO
TMJ ANKYLOSIS AND
SECONDARY FACIAL
DEFORMITY

14. GARRES’ OSTEOMYLITIS
NON SUPPURATIVE TYPE
CARLE GARRE 1893
PELL 1955 - IN MANDIBLE
CHILDRENS AND YOUNG ADULT
GENERALLY IN THE MANDIBLE
PHERIPHERAL SUB PERIOSTEAL BONE DEPOTISION -
DUE TO MILD IRRITATION & INFECTION
RADIOGRAPHICALLY - OCCLUSAL VIEW - CORTICAL
THICKENING
DD- INFANTILE CORTICAL HYPEROSTOSIS (CAFFEY’S DISEASES
)
REMOVE THE CAUSE - WAIT & WATCH
OCCATIONALLY - RECONTOURING IS PERFORMED

15. PERIOSTITIS
THICKENING OF THE OUTER
CORTEX
REACTIVE BONE FORMATION

16. HYPER BARIC OXYGEN
ADJUVENT THERAPY
100% OXYGEN UNDER PRESSURE
TO THE CHAMBER – DIVE
HYPOXIC
HYPOCELLULAR
HYPOVASCULARITY
taken care by H B O

17. 90 mts DIVE – IN MONO PLACE CHAMBER

18. OSTEORADIONECROSIS
Complication after irradiation
IRRADIATION
TRAUMA
INFECTION

19. CLINICAL FEATURE
PAIN & SWELLING
RADIATION CARIES
(DEMINERALIZATION OF THE TOOTH STRUCTURES)
MUCOSITIS
DECREASED SALIVARY SECREATIONS
SEQUESTRATION OF THE BONE
CHRONIC SINUS DISCHARGE
SKIN INFECTION

20. PREVENTION
PREPARE THE ORAL CAVITY FOR
IRRADIATION
MAINTAIN GOOD ORAL HYGEINE
EXTRACT ALL INFECTED AND NON VITAL TOOTH
EXTRACT PERIODONTALLY WEEK TOOTH
TOTAL EXTRACTION CAN BE PERFORMED IN CASE OF
HEAVY IRRADIATION
PRE & POST IRRADIATION ANTI BIOTICS
FLOURIDE THERAPY TO PREVENT IRRADIATION CARIES
SUFFICIENT TIME FOR IRRADIATION AFTER EXTRACTION

21. PEVENTION IS THE CURE FOR ORN

22. MANAGEMENT OF ORN
PARENTRAL ANTIBIOTICS
( FLAGYL)
DEBRIDEMENT WITH H2O2
( ANTIBIOTICS )
ANTIBIOTIC DRESSING
H B O
SURGICAL RESECTION OF THE AFFECTED PART

23. RESECTION &
RECONSTRUCTION
RIM RESECTION / SEGMENTAL
INTRA ORAL / EXTRA ORAL
LA / GA

24. Osteoradionecrosis

25. THANK YOU