(a) CT scan (bone windowing) demonstrates a nonexpansile, osteolytic lesion (arrow) within the right mandible. Perimandibular soft-tissue inflammatory change (arrowheads) is also present.
Chronic suppurative osteomyelitis with three sequestra (arrows). Osteolytic as well as sclerotic areas are present.
CT scan reveals an osteolytic lesion (arrow) containing a bony sequestrum (arrowhead) within the left mandibular body.
It is suggested that trauma and infection causes inflammation of the bone marrow which causes release of tissue activators. Plasminogen which is present in the clot is converted into plasmin by the action of tissue activators. Plasmin is a fibrinolytic agent and will dissolve the blood clot. It will also release kinins which will cause severe pain to the patient.
Presented by:Fasahat Ahmed Butt (36Group: C1
• What is osteomyelitis?• Predisposing factors of osteomyelitis?• ClassificationClinical featuresRadiographic features• Management of osteomyelitis• What is Alveolar osteitis?• PathogenesisClinical features• Treatment
• Osteon: Bone• Myelitis: Inflammation of the bone marrow• Acute or chronic inflammatory process in themedullary spaces or cortical surfaces of the bonethat extends away from the initial site ofinvolvement
Decreased vascularityor Vitality of bone• Trauma• Radiation injury• Paget’s disease• Osteoporosis• Major vessel diseaseImpaired host defence• Immune deficiency state• Immunosuppression• Diabetes Mellitus• Malnutrition• Extremes of ageLocal factors Systemic factors
Organism enters the jaw (mandible) blood supplyMedullary infection spreads through marrow spacesThrombosis, bone necrosisLacunae empty of osteoid filled with neutrophil & bacteriaproliferate in dead tissueProliferation of periosteum & sinus formationSequestrum separated once removed, new bone isformed (INVOLUCRUM)
• Localized inflammation of the bone following:Failure of blood clot to form in the socketPremature loss of the clotDisintegration of the clot• Common complication followingtooth extraction
Food debris Bacteria SalivaEmpty socketBone becomesinfected &necroticInflammatoryreactions in theadjacent marrowLocalizes it tothe socket wallOsteomyelitisNecrotic bone isseparated byosteoclastTinysequestraProliferation ofgranulation tissue fromsurrounding vital boneHEALING
• Location: Mandible in posterior areas.• No sex predilection• Severe pain• Radiates to ear and neck• Foul odor• Lymphadenopathy• Trismus
• Administration of regional local anesthesia• Debridement of socket wall• Irrigate with normal saline• Antiseptic/analgesicAlvogelZinc oxide/eugenol packChlorhexidine gelTetracycline packNO drainage.
• Chlorhexidine mouth rinses should be done gently.• Patient should not smoke minimum for 48 hours afterextraction.• Patient should avoid sucking, spitting or drinking throughthe straw.• Patient should try to maintain good oral hygiene
• CAWSON• J.V. SOAMES & J.C. SOUTHAM• NEVILLE & DAMM• GOOGLE for images