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Osteomyelitis
This document discusses osteomyelitis and alveolar osteitis. It defines osteomyelitis as an inflammatory process in the bone marrow or cortical surfaces that extends from the initial site of involvement. It then discusses predisposing factors, classifications, clinical features, radiographic features, and management of osteomyelitis. It also defines alveolar osteitis as localized inflammation of the bone following failure of a blood clot or socket, discusses its pathogenesis and clinical features, and outlines its treatment.
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Osteomyelitis
- 1. Presented by: Fasahat AhmedButt (36 Group: C1
- 2. • What isosteomyelitis? • Predisposing factors of osteomyelitis? • Classification Clinical features Radiographic features • Management of osteomyelitis • What is Alveolar osteitis? • Pathogenesis Clinical features • Treatment
- 3. • Osteon: Bone •Myelitis: Inflammation of the bone marrow • Acute or chronic inflammatory process in the medullary spaces or cortical surfaces of the bone that extends away from the initial site of involvement
- 4. Decreased vascularity or Vitalityof bone • Trauma • Radiation injury • Paget’s disease • Osteoporosis • Major vessel disease Impaired host defence • Immune deficiency state • Immunosuppression • Diabetes Mellitus • Malnutrition • Extremes of age Local factors Systemic factors
- 5. • SUPPURATIVE OSTEOMYELITIS •FOCAL SCLEROSING OSTEOMYELITIS • DIFFUSE SCLEROSING OSTEOMYELITIS • PROLIFERATIVE PERIOSTITIS
- 6.
- 7. • Bacteroids • Porphyromonas •Prevotella Staphylococcus (open fractures)
- 8. Organism enters thejaw (mandible) blood supply Medullary infection spreads through marrow spaces Thrombosis, bone necrosis Lacunae empty of osteoid filled with neutrophil & bacteria proliferate in dead tissue Proliferation of periosteum & sinus formation Sequestrum separated once removed, new bone is formed (INVOLUCRUM)
- 10. • Location: Mandible •Male: Adult males • Pain • Soft tissue swelling • Fever • Lymphadenopathy
- 11. • It maybe normal in the early stages of the disease, but after 10-14 days sufficient bone resorption may have occurred to produce irregular, MOTH-EATEN areas of radiolucency.
- 12. C/F • Swelling • Pain •Sinus formation • Tooth loss • Sequestrum formation
- 13. • ILL-defined radiolucencythat often contains central radiopaque sequestra.
- 15. C/F • Age: Childrenand young adults • Location: Mandibular premolar and molar • Bone sclerozing associated with non vital pulpitic tooth
- 16. • Increased areasof radiodensity surround the apices of non-vital mandibular 1st molar
- 17. C/F • Age: Adults •No sex predilection • Location: Mandible • Sclerosing around the site of periapical/PD inflammation • Persistent pain • No swelling
- 18. • Radiodencities • Scleroticbone seen in tooth bearing area
- 19. C/F • Age: Childrenand young adults. • Location: Lower border of the mandible. • No sex predominance.
- 20. • New periostealbone formation along the inferior border of the mandible • CT image: new periosteal bone growth with onionskin lamination
- 21. Essential measures: Bacterial samplingand culture Vigorous (empirical) antibiotic treatment Drainage Analgesic Specific antibiotics Debridement Adjunctive treatment: Sequestrectomy Decortication Resection and reconstruction for extensive bone destruction Hyperbaric oxygen For acute osteomyelitis antibiotic treatment for 4-6 wks For chronic osteomyelitis treatment is carried for 12 wks
- 23. • Localized inflammationof the bone following: Failure of blood clot to form in the socket Premature loss of the clot Disintegration of the clot • Common complication following tooth extraction
- 24. Food debris BacteriaSaliva Empty socket Bone becomes infected & necrotic Inflammatory reactions in the adjacent marrow Localizes it to the socket wall Osteomyelitis Necrotic bone is separated by osteoclast Tiny sequestra Proliferation of granulation tissue from surrounding vital bone HEALING
- 25. • Location: Mandiblein posterior areas. • No sex predilection • Severe pain • Radiates to ear and neck • Foul odor • Lymphadenopathy • Trismus
- 27. • Administration ofregional local anesthesia • Debridement of socket wall • Irrigate with normal saline • Antiseptic/analgesic Alvogel Zinc oxide/eugenol pack Chlorhexidine gel Tetracycline pack NO drainage.
- 28. • Chlorhexidine mouthrinses should be done gently. • Patient should not smoke minimum for 48 hours after extraction. • Patient should avoid sucking, spitting or drinking through the straw. • Patient should try to maintain good oral hygiene
- 29. • CAWSON • J.V.SOAMES & J.C. SOUTHAM • NEVILLE & DAMM • GOOGLE for images
Editor's Notes
- #12 (a) CT scan (bone windowing) demonstrates a nonexpansile, osteolytic lesion (arrow) within the right mandible. Perimandibular soft-tissue inflammatory change (arrowheads) is also present.
- #14 Chronic suppurative osteomyelitis with three sequestra (arrows). Osteolytic as well as sclerotic areas are present.
- #15 CT scan reveals an osteolytic lesion (arrow) containing a bony sequestrum (arrowhead) within the left mandibular body.
- #24 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.