Osteomyelitis/certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL
ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Good afternoon

Learning objectives
At the end of the session learner should be able to:
• Initiate & perform examination of the patient with
maxillary sinus pathology.
• Order and interpret the necessary radiographs.
• Differentiate the pathology from other similar lesions.
• Prescribe laboratory investigations if required.
• Interpret histopathological features of the condition.
• Arrive at final diagnosis.
• Formulate prognosis of the condition.

DEMOGRAPHIC DETAILS
• Reg.no: 1204020060
• Date:02/04/2012
• Name: Sulochana Podbandhe.
• Age: 48 yrs
• Sex: Female
• Address: Hadgaon, Dist.Nanded.

Extraoral examination

Intraoral examination

Provisional diagnosis
• Chronic periapical abscess with 6
leading to extraoral draining sinus.

Investigations done
• OPG
• PNS VIEW
• CT SCAN
• HAEMATOLOGICAL INVESTIGATIONS.

OPG

PNS VIEW

CT AXIAL

CT: CORONAL VIEW

Clinicoradiographically S/O
• Chronic suppurative osteomyelitis of left
maxillary region and left maxillary
sinusitis.

Hematological investigation
• Hb% - 11.7 gm%
• WBC – 9,000 /Cumm
• Platelet count – 2.29 lakhs / cumm
• PCV – 34.0 %
• Random plasma glucose – 96.8 gm%
• HIV- I & II – Negative
• AFB – Negative
• Hbs Ag - Negative

MANAGEMENT OF
MAXILLARY SINUSITIS
DEPT OF ORAL AND
MAXILLOFACIAL
SURGERY

• The management of sinusitis can be divided into:
• Medicinal treatment
• Surgical treatment
• In cases with allergic sinusitis antihistaminics and
decongestants are prescribed. Antibiotics are often
prescribed to prevent secondary infection.
• The above mentioned treatment comprising of antibiotics,
antihistaminics and decongestants and steam inhalation
are collectively called as “sinus regime”.

• Caldwell – Luc Operation
• It is the surgical procedure for accessing the
maxillary sinus. It can be done for diagnostic
(biopsies of intra antral growths) or for therapeutic
purpose.
• The Caldwel – Luc’s operation is performed under
general anesthesia.
• An intra oral degloving incision is taken in the labial
vestibule over the canine fossa

• The bone is exposed. The round bony cut is marked over
the canine fossa using a round bur (post stamp incision)
and the incision is completed with a fissure bur or an
ossisector.
• When a pre existing oro-antral fistula is present, the
same bony defect is widened to create an access to the
sinus.
• The opening should be wide enough to permit adequate
access to the sinus. (approximately of the size of the
index finger).

• The diseased lining is gently curetted. As the lining
is inflamed, it tends to bleed on provocation, which is
cleared by suction or intermittent packing using roller
gauze.
• Extraction of upper left 6 was done and thorough
curretage of extraction socket was done.
The pack left in situ for achieving haemostasis, and
intra oral incision is closed primarily.

• Nasal antrostomy – the nasal antrostomy done in the
inferior turbinate is very useful in establishing a
dependent drainage of the sinus.
• It is a simple procedure done under local anesthesia
using a trochar and canula on outdoor basis.

• The sinus regime is started and continued for 8-10
days.
• The excised lining along with curreted material of
socket was submitted for histopathological
examination.

Grossing details
Size- ( 1.5x 1.5x 1)cm
Shape- roughly oval
Consistency- hard
Color- brownish

Size- ( 1.2x 1 x 1)cm
Shape- roughly oval
Consistency- soft to firm
Color- brownish

Under scanner view
Pseudostratified ciliated
epithelium
Inflammatory cell
infiltration

Under scanner view
Reversal line
Empty
lacunae
Necrotic
bone

Under low power
Empty lacunae
Howship’s
lacunae

UNDER HIGH POWER
Necrotic bone
Empty lacunae

Final diagnosis
• Clinicoradiopathological diagnosis is
Maxillary sinusitis with Chronic
Suppurative Osteomyelitis

DISCUSSION
• The word “osteomyelitis” originates from the
ancient Greek words osteon (bone) and
muelinos (marrow) .
• Osteomyelitis is usually defined as the
inflammation of bone and its marrow contents.

• It can therefore be considered as an
inflammatory condition of the bone, beginning
in the medullary cavity and havarsian systems
and extending to involve the periosteum of the
affected area.

CLASSIFICATION OF
OSTEOMYELITIS OF JAW
I. Acute suppurative osteomyelitis
II. Chronic suppurative osteomyelitis (sclerosing
osteomyelitis)
III.Chronic focal sclerosing osteomyelitis
(condensing osteomyelitis)
IV.Chronic diffuse sclerosing osteomyelitis

V. Chronic osteomyelitis with proliferative periostitis
(Garrè's chronic nonsuppurative sclerosing osteitis,
ossifying periostitis)
VI. Specific osteomyelitis
1. Tuberculous osteomyelitis
2. Syphilitic osteomyelitis
3. Actinomycotic osteomyelitis

ETIOLOGY
• There are several etiological factors, such as traumatic
injuries, radiation, and certain chemical substances,
among others, which may cause inflammation in the
medullary space of the bone.
• However, acute and secondary chronic osteomyelitis
represent a true infection of the bone induced by
pyogenic micro-organisms (S. aureus, S. epidermidis,
and Actinomyces).

PATHOGENESIS
• Organisms may reach the bone by-
1. Hematogenous spread,
2. Extension from a contiguous site,
3. Direct implantation.

Sequence of events
Bacteraemia
Inflammation
Increased intra-osseous pressure
Obstructed venous return & thrombosis
Necrosis of bone ( Sequestrum)
Suppuration
Pus breaks through to form sub-periosteal abscess
Periosteum is stripped
New bone forms underneath (Involucrum)
Once sequestra & involucrum have formed,
the disease is chronicwww.indiandentalacademy.com

COMPLICATIONS
• Osteonecrosis
• Septic arthritis
• Impaired growth
• Squamous cell carcinoma

THANK YOU !!!

Osteomyelitis/certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Osteomyelitis/certified fixed orthodontic courses by Indian dental academy

Similar to Osteomyelitis/certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Osteomyelitis/certified fixed orthodontic courses by Indian dental academy