Osteomyelitis is an inflammation of the bone marrow that begins as an infection in the medullary cavity and spreads to involve the bone and periosteum. It can be caused by local trauma, systemic conditions like diabetes that impair blood flow, or infections from other sites like the teeth, middle ear, or lungs. Symptoms include pain, swelling, fever. It is classified based on duration (acute vs chronic), presence of pus (suppurative vs non-suppurative), location in bone, and specific causative infection. Treatment involves antibiotics, removal of infected or dead bone, drainage of pus, and sometimes surgery.

1. Osteomyelitis
Presented by : Ankit Thummar A.
Roll No.:- 92
Batch : H

2. • Osteomyelitis is defined as an inflammation of the
medullary portion of the bone. The process rarely is
confined to the endosteum and usually affects the cortical
bone and the periosteum.
• osteomyelitis may be defined as an inflammatory condition
of the bone that begins as an infection of the medullary
cavity, rapidly involves the Haversian system and quickly
extends to the periosteum
• Osteon = Bone, Myelos = Bone Marrow (in Greek word)
N.b. Don’t confused with Myositis and Myelitis
Definition

3. Local factors Systemic factors Conditions altering
vascularity of bone
Trauma and road traffic
accidents
Diabetes Radiation
splints Agranulocytosis Paget’s disease of bone
gunshot wounds Leukaemia osteopetrosis
Severe Anaemia bone malignancy
Malnutrition Fibrous Dysplasia
Chronic Alcoholism Osteoporosis
Sickle cell disease
febrile illnesses
such as typhoid,Scarlet
Fever
Predisposing Factor

4. 1. Odontogenic Infection
2. Compound fracture of the jaws
3. Traumatic injury
4. Middle ear infection and
Respiratory infection
5. Infection from periostitis after
gingival ulceration, lymph nodes,
Furunculosis of chin
6. Peritonsillar abscess
Etiology

5. Pathogenesis

7. Sequelae of
Pulpitis

8. According to
anatomic
location of
infectious
process:
According to
duration and
severity:
Depending on
Suppuration:
Osteomyelitis
due
to specific
infection:
Intra-medullary Acute Suppurative Actinomycosis
Sub-periosteal Chronic Non - Suppurative Tuberculosis
Periosteal Syphilis
Classification

9. Suppurative
 Acute suppurative
osteomyelitis
 Chronic suppurative
osteomyelitis
1.Primary
2.Secondary
 Infantile osteomyelitis
Non Suppurative
 Chronic nonsuppurative
OML
1. Focal Sclerosing
2. Diffuse Sclerosing
 Radiation osteomyelitis
 Garre's sclerosing
osteomyelitis
Based on Suppuration

10. Acute Suppurative OML
It is a serious sequelae of periapical infection that often results in a diffuse spread of
infection throughout the medullary spaces with subsequent necrosis of a variable
amount of bone
 Clinical Feature :
Deep Intense Jaw Pain
Abscess Formation
High Intermittent Fever
Paresthesia of Lip
No fistula, Diffuse Swelling, Mobile teeth, Trismus
 Radiographic Feature:
- Moth Eaten Appearance

11.  Clinical Feature:
Paraesthesia of the lip may be seen, though not classically seen in
chronic suppurative osteomyelitis
It develop after acute phase of the disease has subsided (secondary), or
it may arise from a dental infection without a preceding acute stage
(primary)
 Radiographic Feature:
Irregular radiolucent areas superimposed on more sclerotic and
nontrabeculated zones
Chronic Suppurative OML

12. Chronic Focal Sclerosing OML
 Clinical Feature:
occurs in cases of extremely high tissue resistance or in cases of low-
grade medullary infection which causes endosteal or periosteal reactions.
Most common in younger individuals in the mandibular first molar region
with mild pain and decreased sensitivity in the tooth
 Radiographic Feature:
well circumscribed radiopaque mass of
sclerotic bone surrounding and extending
below the apex of one or both roots

13. Chronic Diffuse sclerosing OML
 Clinical Feature:
It Occur at any age
first symptom may be a fistula on the mucosal surface
patient may complain of vague pain and a bad taste.
chronic condition & represents a proliferative reaction of the bone to a low-grade
infection
 Radiographic Features
cotton wool appearance

14.  Clinical Feature:
It occurs commonly in children and young adults.
Mandible is affected more commonly than maxilla.
toothache or pain in the jaw and bony hard swelling in the outer surface of the jaw.
 Radiographic Feature:
Onion Skin Appearance
Chronic Osteomyelitis with Proliferative Periostitis Or
Garre’s Osteomyelitis Or Periostetitis Ossificans

15. Infantile osteomyelitis is believed to occur by haematogenous
route or from perinatal trauma that occurs few weeks after birth and usually
involves the maxilla.
 Clinical Feature:
Facial cellulitis centred about the orbit
Inner and outer canthal swelling
Palpebral oedema
Closure of the eye and proptosis
Purulent discharge from the nose and medial canthus
Generalised symptoms : fever, irritability, malaise, anorexia, dehydration,
convulsions and vomiting
Infantile
Osteomyelitis

16. Treatment of Osteomyelitis
Primary Treatment Measure Supportive Measures
Empirical Therapy of Antibiotics Sequesterectomy
Analgesics Saucerisation
Incision & Drainage Decortication
Removal of Offending teeth Resection & Reconstruction
Debridement Hyperbaric Oxygen Therapy
Bed Rest & Tx. of underlying disease

17. • Removal of sequestrum
• It may be carried out under proper cover of antibiotics
• Small Sequestrum → Under Local Anesthesia
• Bigger Sequestrum → Under General Anesthesia
• Involved site & Incision
Sequestrectomy
Involved Site Incision
For Lower border of mandible Risdon'sIncision
Ramus of Mandible Retromandiblur Incision
Coronoid Process Anterior broeder of ramus of
mandible
Consular Process Preauricular Incision

18. • After removal of the sequestrum the residual granulation tissue is
curetted till white shining bone appears.
• Bleeding is controlled by pressure pack
• When complete infection has been eradicated the wound can be closed
by primary closure
• When the elimination of the infection is doubtful, a glove drain or a
rubber drain is kept in place and is changed every 24 hours till no
discharge from the bone

19. • Sufficient bone is removed to convert the deep cavity into Shallow saucer
• It consists of elimination for bony cavity in the jaw bone to avoid collection of blood
and formation of large hematoma which is liable to get infected
• Saucerization is carried out by existing the wall of the bony cavity by means of
Rongeur bone-cutting forceps or burs and bone is smoothen by file
• The wound can be partially or completely closed depending upon the amount of
suppuration
Saucerization

20. Decortication:
First introduced in 1917 by Mowlem
Decortication involves removal of the chronically infected
cortex, usually the buccal and the inferior border are removed
1–2 cm beyond the affected area

21. Resection & Reconstruction
Excision of a part of the mandible is seldom necessary
Antibiotic therapy is started 24 h before operation
IMF is done, reconstruction plate contoured and screws. drilled
before resection in order to maintain preoperative occlusion
Partial resection involves
preservation of the condylar and coronoid processes
Total disarticulation of the mandible involves complete stripping of
the
coronoid and condylar processes

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