Osteomyelitis is a challenging disease for clinicians with a significant morbidity unless it is recognized immediately and treated promptly
Early recognition and prompt treatment can prevent extensive loss of bone and teeth.
Proper management depends on careful clinical and imaging examination, proper assessment of findings and understanding the nature of disease.
DENTIGEROUS CYST- an odontogenic cyst that surrounds the crown of impacted tooth , develops by fluid accumulation between REE(reduced enamel epithelium) and the enamel surface , resulting in a cyst which the crown located within the lumen.
Solitary oral ulcers and systemic diseasesDr. Harsh Shah
A brief overview of different ulcerative lesions seen in the oral cavity linked to the dangerous systemic diseases and preventive measures for the disease before it turns lerhal
SDDCH, Parbhani
DENTIGEROUS CYST- an odontogenic cyst that surrounds the crown of impacted tooth , develops by fluid accumulation between REE(reduced enamel epithelium) and the enamel surface , resulting in a cyst which the crown located within the lumen.
Solitary oral ulcers and systemic diseasesDr. Harsh Shah
A brief overview of different ulcerative lesions seen in the oral cavity linked to the dangerous systemic diseases and preventive measures for the disease before it turns lerhal
SDDCH, Parbhani
TMJ is a ginglymo-diarthroidal joint that is freely mobile with superior and inferior joint spaces separated by articular disc.
The type of imaging technique depends upon the clinical problems associated, so either imaging of hard tissue (OSSEOUS) or soft tissue is desired.
Certain protocols are to be taken care before the imaging procedure:
the amount of diagnostic information available from particular imaging modality.
The cost of examination
The radiation dose
In this presentation, it describes about the periapical diseases, for dental students.
very useful for endodontic purpose.
remember it does not include the pulpal diseases.
Dentin dysplasia (DD) is a rare hereditary disturbance is inherited as an autosomal dominant trait.
unknown etiology that affects approximately 1 :100,000.
In 1972, Witkop classified it into type I and type II which affect both dentitions.DD Type I
Radicular dentin dysplasia
Characterized by:-
1.Both dentitions are affected.
2.Normal appearing crowns
3.No or only rudimentary root development (rootless teeth)
4.Incomplete or total obliteration of the pulp chamber.
5.Teeth may exhibit extreme mobility and exfoliate prematurely.DD type II
coronal dentin dysplasia
Characterized by:-
1.partial pulpal obliteration.
2.Thistle-tube-or flame-shaped coronal pulp chambers
3. Thread-like root canals
4. Usually the absence of periapical radiolucencies.
5. In this type of anomaly, teeth roots are of normal shape and contour.The enamel and the immediately subjacent dentin appear normal.
Deeper layers of dentin show an atypical tubular pattern with an amorphous, atubular area, and irregular organization.
Normal dentinal tubule formation appears to have been blocked so that new dentine forms around obstacles and takes on the characteristic appearances described as “lava flowing around boulders”The radiograph revealed features of dentine dysplasia type I with normal appearance of crown but no root development Autosomal Dominant Disorder:
Manifested in heterozygous states
At least one parent of index case is usually affected
Both males and females are affected.
Clinical feature can be modified by variation in penetrance and expressivity. Some individual inherit the mutant gene but are phenotpically normal. This is reffered to as “incomplete penetrance”.
In many condition the age of onset is delayed.
Inheritance Pattern:
Typical pattern is a heterozygous affected parent with a homozygous unaffected parent.
Every child has one chance in two of having the disease
Both sexes are affected equally..Autosomal Recessive Disorder
Largest category of Mendelian disorder
Usually does not affect the parent of the affected individual, but sibling may show the disease.
Complete penetrance is common.
Onset is frequently early in life.
Usually affect enzymatic proteins.
Pattern Of Inheritance:
Typical pattern is two heterozygous unaffected (carrier) parent.
The triat does not usually affect the parent, but siblings may show the disease
Siblings have one chance in four of being affected
Both sexes affected equally.
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on osteomyelitis of jaw which helps for a quick refresh.
Classification, management described in detail for easy understanding of the subject.
TMJ is a ginglymo-diarthroidal joint that is freely mobile with superior and inferior joint spaces separated by articular disc.
The type of imaging technique depends upon the clinical problems associated, so either imaging of hard tissue (OSSEOUS) or soft tissue is desired.
Certain protocols are to be taken care before the imaging procedure:
the amount of diagnostic information available from particular imaging modality.
The cost of examination
The radiation dose
In this presentation, it describes about the periapical diseases, for dental students.
very useful for endodontic purpose.
remember it does not include the pulpal diseases.
Dentin dysplasia (DD) is a rare hereditary disturbance is inherited as an autosomal dominant trait.
unknown etiology that affects approximately 1 :100,000.
In 1972, Witkop classified it into type I and type II which affect both dentitions.DD Type I
Radicular dentin dysplasia
Characterized by:-
1.Both dentitions are affected.
2.Normal appearing crowns
3.No or only rudimentary root development (rootless teeth)
4.Incomplete or total obliteration of the pulp chamber.
5.Teeth may exhibit extreme mobility and exfoliate prematurely.DD type II
coronal dentin dysplasia
Characterized by:-
1.partial pulpal obliteration.
2.Thistle-tube-or flame-shaped coronal pulp chambers
3. Thread-like root canals
4. Usually the absence of periapical radiolucencies.
5. In this type of anomaly, teeth roots are of normal shape and contour.The enamel and the immediately subjacent dentin appear normal.
Deeper layers of dentin show an atypical tubular pattern with an amorphous, atubular area, and irregular organization.
Normal dentinal tubule formation appears to have been blocked so that new dentine forms around obstacles and takes on the characteristic appearances described as “lava flowing around boulders”The radiograph revealed features of dentine dysplasia type I with normal appearance of crown but no root development Autosomal Dominant Disorder:
Manifested in heterozygous states
At least one parent of index case is usually affected
Both males and females are affected.
Clinical feature can be modified by variation in penetrance and expressivity. Some individual inherit the mutant gene but are phenotpically normal. This is reffered to as “incomplete penetrance”.
In many condition the age of onset is delayed.
Inheritance Pattern:
Typical pattern is a heterozygous affected parent with a homozygous unaffected parent.
Every child has one chance in two of having the disease
Both sexes are affected equally..Autosomal Recessive Disorder
Largest category of Mendelian disorder
Usually does not affect the parent of the affected individual, but sibling may show the disease.
Complete penetrance is common.
Onset is frequently early in life.
Usually affect enzymatic proteins.
Pattern Of Inheritance:
Typical pattern is two heterozygous unaffected (carrier) parent.
The triat does not usually affect the parent, but siblings may show the disease
Siblings have one chance in four of being affected
Both sexes affected equally.
Dr, Kathirvel Gopalakrishnan
M.D.S (OMFS)
Presentation on osteomyelitis of jaw which helps for a quick refresh.
Classification, management described in detail for easy understanding of the subject.
As heart is to the body, the pulp is to the tooth, providing a constant source of nutrition to maintain the vitality of a tooth. Every precaution should be taken to preserve vitality of the pulp. A simple dental infection if neglected , can proceed to life threatening complications. So early detection , early treatment and early prevention is very important.
Structural complexity and regional variability of oral mucosa poses a challenge to its proper understanding.
But it is must to understand the morphology, histology and physiology
Many systemic diseases, cause characteristic change in the oral mucosa and careful examination can help in early diagnosis.
Forensic Odontology is defined as that branch of dentistry which, in the interest of justice, deals with the proper handling and examination of dental evidence with proper evaluation and presentation of dental findings.
Forensic dentistry plays a major role in the identification of those individuals who cannot be identified visually or by other means.
The unique nature of our dental anatomy & the placement of custom restorations ensure accuracy when the techniques are correctly employed.
Each case presents individual challenges that have to be understood and then overcome.
As most dental evidence will disappear or degrade over time, sometimes there is only one opportunity to do it right.
Practice (not actual casework) makes for acceptable results.
BENIGN TUMOUR : Is a new growth, which is limited by a capsule and grows by local expansion without causing any harm to the host, excepting its position in a vital organ.
MALIGNANT TUMOUR : Is a new growth which is characterized by rapid growth, sign of invasion, absence of capsule and last of all dissemination to other parts of the body usually by hematogenous or lymphatic route or both.
Intraoral radiographic processing and faultsRuchika Garg
Every radiographic examination should produce radiographs of optimal diagnostic quality.
Radiographs should record the complete area of interest and should have minimal possible distortion.
Improper positioning of receptor and x-ray tube and faulty processing can adversely affect the quality of a properly exposed radiograph.
Thus close attention should be paid to optimize these parameters.
Those who administer ionizing radiation must become familiar with the magnitude of exposure encountered in medicine, dentistry and every day life; the possible risks associated with such exposure; and the methods used to affect exposure.
Practitioners should remain informed about safety updates to further improve diagnostic quality of radiographs and decrease radiation exposure.
Extra oral radiography means that the source as well as film are placed outside the mouth & an exposure is made in order to obtain the images on a recording medium. Extra oral radiography provides wider anatomic coverage on a single film.
Introduction, History , Types of inflammation, Cellular events, Vascular events, Morphology of inflammation, Systemic effects of inflammation, Fate of inflammation
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. References
• Textbook of Oral & Maxillofacial Infections 4th edition : Richard G. Topazian.
• Osteomyelitis of the jaws : Marc M Baltensperger and Gerold K Eyrich
• Textbook of Oral Pathology 6rth edition : Shafer Hine Levy
• Diagnostic imaging of the jaws : Langland & Langlais
• Textbook of Oral Radiology : White & Pharoah.
• Aliya A Khan et al. Diagnosis and Management of Osteonecrosis of the Jaw: A Systematic
Review and International Consensus. Journal of Bone and Mineral Research, Vol. 30, No. 1,
January 2015, pp 3–23 DOI: 10.1002/jbmr.2405.
• Deepak Gupta et al. Role of Maxillofacial Radiology and Imaging in the diagnosis and Treatment
of Osteomyelitis of the Jaws. Dentistry, Oral Disorders & Therapy.
20. Radiological Features
• In early stage there is widening of marrow spaces giving a
mottled appearance
• Granulation tissue b/w dead & living bone gives irregular lines
& zones of radiolucency resulting in moth -eaten appearance.
• In later stages the devitalized bone appears sclerosed & called
sequestrum.
• Large areas of bone destruction seen as radiolucent areas.
21. Axial CT Scan showing the sequestrae (white arrow) & bone
reaction — black arrow
22. Five Different Radiographic Appearances Of
Chronic Osteomyelitis
1. Radiolucency with ragged borders
2. Radiolucency containing one or more radio-opaque foci
3. A salt and pepper appearance
4. A dense radio-opacity
5. A cortical radiolucency
23. Infantile Osteomyelitis
• Etiology –
• Forcep-delivery
• Trauma caused to oral mucosa during delivery
• Infection of maxillary sinus
• Contaminated human or artificial nipples
• Infections from nose
• Hematogenous spread
C/F --
1) Sudden onset of high grade fever , anorexia , irritability.
2) Redness & swelling over mid face.
3) Purulent discharge - below median canthus of eye.
4) Sub periosteal abscess- draining sinus tracts.
5) Poor feeding.
R/F – Minimal bone loss
In later stages sequestra & necrotic tooth germs
25. Chronic Focal Sclerosing Osteomyelitis
• Unusual reaction of bone
• Clinical features
Age
Site
Symptoms
Radiological features
26. Five patterns of Condensing Osteitis
• Radio-opaque area not surrounded by perilesional halo.
• Target lesion surrounded by perilesional halo.
• Granular or lucent pattern.
• Multifloculent
• Associated with external root resorption.
27. Chronic Diffuse Sclerosing Osteomyelitis
Clinical features
Age - Older
Sex – No predilection
Site – Edentulous areas
Symptoms – Mild expansion of jaw, episodes of recurrent swelling
29. Chronic Osteomyelitis with Proliferative
Periostitis
• Also called Garre’s sclerosing Osteomyelitis
Proliferative periostitis
Periostitis ossificans
• First described by CARL GARRE in 1893.
32. Tuberculous Osteomyelitis
• Clinical features
i. Involvement of mandible is more
ii. Painless swelling
iii. Loosening of teeth
iv. Sequestration of bone
v. C/o chronic discharging sinus
vi. Palpable lymph nodes
33. RADIOGRAPHIC EXAMINATION
OPG
PA mandible
Lateral oblique view of mandible.
Well defined radiolucency with destruction of buccal or medial
cortical plates
DIAGNOSIS
o Culture for pus – Test for acid fast bacilli
o Culture for sputum—AFB
o Mantoux test
o Biopsy of lesion
34. Actinomycotic Osteomelitis
Site
• Angle of mandible
• Posterior aspect of body
Radiological features
• Radiolucent area at apex of one / more teeth.
• Well defined radiolucency with a sclerotic bone at periphery : CYST LIKE
• Scattered area of bone destruction separated by normal /sclerosed bone.
• Shadow of tooth socket with increasing density of adjacent bone.
36. Nocardial Osteomyelitis
• Resembles actinomycosis
• Causative organism – Nocardia asteroids
• With or without dental injury
• Suppurative lesion with necrosis & abscess formation.
• T/t – drainage , Sulphonamides for 6 wks.
37. Syphilitic Osteomyelitis
• Frequently involved - hard palate.
• The gummatous destruction is painless.
• Syphilitic osteomyelitis of the jaws is difficult to distinguish from
chronic suppurative osteomyelitis since their radiographic
appearances are similar.
• Maxilla is more affected than mandible
PERIOSTITIS : several layers of new bone parallel to margin of jaw.
“Gross caricature of network / lattice”.
• May lead to oroantral , oronasal communication
• Sequestra is called as Filiary sequestra
38. Osteoradionecrosis
• It is a chronic, non- healing wound caused by hypoxia, hypocellularity
and hypovascularity of the irradiated tissue. (MARX)
• POST- RADIATION OSTEONECROSIS.
• Intense irradiation > 50 Gy.
39. Clinical features
Remain asymptomatic for prolonged periods of weeks, months, or even years.
Signs and symptoms - pain, tooth mobility, mucosal swelling, erythema,
ulceration, paresthesia, or even anesthesia of the associated branch of the
trigeminal nerve.
Intraoral and extraoral fistulae may develop when necrotic mandible or maxilla
becomes secondarily infected.
Chronic maxillary sinusitis secondary to osteonecrosis with or without an oral-
antral fistula may be the presenting feature in patients with maxillary bone
involvement.
40. Classification of Osteoradionecrosis
Stage 0 : Exposure of mandibular bone for less than one month; no distinct
changes on plain radiographs (panoramic radiograph or periapical film).
Stage I : Exposure of mandibular bone for at least one month; no distinct changes
on plain radiographs (panoramic radiograph or periapical film).
Asymptomatic e.g. no pain or presence of cutaneous fistulas (I A), or
symptomatic, e.g. pain or presence of cutaneous fistulas (I B).
41. Stage II : Exposure of mandibular bone for at least one month; distinct changes
present on plain radiographs (panoramic radiograph or periapical film), but
not involving the lower border of the mandible.
Asymptomatic otherwise, e.g. no pain or presence of cutaneous fistulas (II A), or
Symptomatic, e.g. pain or presence of cutaneous fistulas (II B).
Stage III : Exposure of mandibular bone for at least one month; distinct changes
on plain radiographs (panoramic radiograph or periapical film), involving
the lower border of the mandible, irrespective of any other signs and
symptoms. Note: In case of doubt about the presence and/or extent of
radiographical bone involvement, the lower stage should be allotted.
42. Conservative therapy
• Maintaining optimal oral hygiene (diligent home self-care and regular
professional dental care), elimination of active dental and periodontal disease,
topical antibiotic mouth rinses, and systemic antibiotic therapy, as indicated.
• Successful treatment of ONJ with teriparatide are encouraging
• Topically applied ozone,
• Bone marrow stem cell intralesional transplantation and
• Addition of pentoxifylline and tocopherol to the standard antibiotic regimen.
• Favorable outcomes have been reported with low-level laser therapy, in
conjunction with conservative and/or surgical debridement.
• Conservative therapy should be continued as long as there is not:
• (1) obvious progression of disease;
• (2) pain that is not being controlled by conservative means; or
• (3) a patient who has had antiresorptive therapy discontinued by their
oncologist because of ONJ.
43. Surgical management
• A full-thickness mucoperiosteal flap should be elevated and extended to reveal
the entire area of exposed bone and beyond to disease-free margins.
• Resection of the affected bone should be extended to reach healthy-appearing,
bleeding bone.
• Sharp edges should be smoothed
• It is also proposed that if surgery is indicated, resection with tension-free
closure affords the most positive results.
• Promising results have also been reported with surgical debridement in
combination with platelet-derived growth factor (PDGF) applied to the site
• Cases also reported that intraoperative fluorescence guidance was helpful in
identifying surgical resection margins
• It was suggested that longer-term preoperative antibiotics (23 to 54 days)
resulted in improved surgical outcomes versus short-term antibiotic therapy (1
to 8 days). Adjunctive therapy with hyperbaric oxygen (HBO) in combination
with surgery has been investigated with encouraging results.
48. Antibiotic Regimen
Regimen I:
Hospitalized / Medically Compromised pt. Or When Intravenous Therapy Is
Indicated
• Aqueous Penicillin , 2 Million U Iv 4hrly + Metronidazole, 500mg 6hrly
• When Improved For 48 To 72 Hours: Penicillin V,500mg 4hrly+
Metronidazole, 500mg 6hrly For 4 To 6 Wks.
Or
• Ampicillin / Sulbactum 1.5 To 3.0 G IV 6hrly
• When Improved For 48 To 72 Hours: Amoxicllin / Clavulanate
(Augumentin),875/125 Mg Bid For 4 To 6 Wks.
49. Regimen II:
For Outpatient Treatment
• Penicillin V , 2gm + Metronidazole, 500mg 8hrly For 2 To 4 Wks After Last
Sequestra Removed.
Or
• Clindamycin ,600 To 900mg 6hrly Iv , Then
• Clindamycin ,300 To 450mg 6hrly
PENICILLINASE ALLERGIC PTS.
• Clindamycin
• Cefotaxim
50. HBO therapy
• Involves intermittent daily inhalation of 100% O2 through face mask or
large chamber at 2.4 atm pressure for 90min dives: 5days/ week for 30 /
more sessions followed by 10 / more sessions.
• Functions
• Contraindications
• Complications
51. • HBO therapy involves the intermittent , usually daily , inhalation of 100%
humidified oxygen under pressure , greater than one atmospheric pressure
(ATA).
• HBO reduces the hypoxia within the affected tissues and stimulates
angiogenesis in the hypo vascular tissues .
• It enhances phagocytic activity of leucocytes to stimulate fibroblast growth ,
increase in collagen formation and promote growth of new capillaries.
52. • Patient is placed in a chamber.
• Oxygen is given by mask or by hood .
• Each dive is 90 minute in length.
• 5 days per week for 30,60, or more dives at 2.4 ATA for 90 minutes while
breathing 100% oxygen twice daily.
• Protocol of MARX (1983)
30 initial dives , if improved then 60 dives completed.
Otherwise , SEQUESTRECTOMY + 30 dives , if wound dehiscence, RESECTION +
60 dives & 20 dives after 10 weeks
Patient with pathological # ,oro-cutaneous fistula are given 30 dives more prior
going to resection
53. Contraindications by Fisher (1988) & Marx(1985)
1. Pneumothorax
2. COPD
3. Optic neuritis
4. Acute viral infection
5. Acute seizures
6. URI
7. Pregnancy
8. Thoracic surgery
9. Ear surgery
54. Conclusion
• Osteomyelitis is a challenging disease for clinicians with a significant morbidity
unless it is recognized immediately and treated promptly
• Early recognition and prompt treatment can prevent extensive loss of bone and
teeth.
• Proper management depends on careful clinical and imaging examination,
proper assessment of findings and understanding the nature of disease,
Editor's Notes
Classification based on clinical picture, radiology, and etiology (specific forms such as syphilitic, tuberculous, brucellar, viral, chemi- cal, Escherichia coli and Salmonella osteomyelitis not integrated in classification)