Osteomyelitis of the jaws

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Osteomyelitis of the jaw is osteomyelitis (which is an infection and inflammation of the bone marrow, sometimes abbreviated OM) occurring in the jawbone (ie the maxilla or lower jaw). Historically, osteomyelitis of the jaw is a common complication of odontogenic infection (dental infection). Before the era of antibiotics, it was often a fatal condition.

Ex and everyday names include osteonecrosis of the jaw (ONJ), cavitation, dry or wet sockets, and NICO (neuralgia-induces Cavitation osteonecrosis). Today, more accurately, the term, jaw osteomyelitis, distinguishes the condition of the relatively new and more familiar iatrogenic phenomenon of Osteonecrosis caused by bisphosphonate in the jaw. The latter was found primarily in post-menopausal women who were given bisphosphonate drugs, usually against osteoporosis.

Video Osteomyelitis of the jaws

Classification

This classification is similar to OM classification generally, according to the length of time the inflammation has been present and whether there is pus (pus formation). Acute osteomyelitis is loosely defined as an OM that has been present for less than a month and chronic osteomyelitis is a term used for more than one month. Supurative suppuratory stomach is rare in developing areas, and is more common in developing countries. In Europe and the United States, most cases follow a dental infection or a mandibular fracture. There are many reported cases occurring in Africa that coexist with acute or orist ulcerative nephrotic gingivitis.

In the pre-antibiotic era, the acute OM of the jaw is wider. A large and diffuse infection usually involves the entire side of the mandible, or the whole from one side and the opposite side as far as the mental foramen. Local osteomyelitis tends to be described as vertical , in which a short segment of the mandibular body from the alveolar peak to the lower bound is involved, and alveolar , where the segment of the alveolar bone up to the level of the inferior alveolar canal alienate, including multiple tooth sockets. Treatment with antibiotics has significantly altered the natural history of OM from the jaw. Today, however, this condition is often a hidden infection, in part because it is not visible in most X-ray teeth. In addition, some dentistry schools do not recognize the "silent" OM of the jaw - the occurrence of conditions without clear visual manifestations - in their curriculum. In addition, because the circulation is intrinsically reduced in the jawbone, antibiotics are often ineffective.

Maps Osteomyelitis of the jaws

Signs and symptoms

The signs and symptoms depend on the type of OM, and may include:

• Pain, severe, throbbing and in sitting.
• Initially the fistula does not exist.
• No dental pain, but headache or other facial pain, as in the previous term descriptive "neuralgia-inducing" (osteonecrosis of cavitation).
• Fibromyalgia.
• Chronic fatigue syndrome.
• Swelling. The external swelling is initially caused by inflammatory edema with erythema (redness), heat and tenderness, and then possibly due to the accumulation of sub-periosteal nan. Finally, the formation of the subperiosteal bone can give a strong swelling.
• Trismus (difficulty opening the mouth), which may be present in some cases and caused by edema of the muscles.
• Dysphagia (difficulty swallowing), which may be present in some cases and caused by edema of the muscle.
• Cervical lymphadenitis (swollen lymph nodes in the neck).
• Aesthesia or paresthesia (altered sensations such as numbness or awl and needle) in the distribution of the mental nerves.
• Fever that may be present in the acute and high and intermittent phase
• Malaise (common unhealthy feeling) that may be present in the acute phase
• Anorexia (loss of appetite).
• Leucocytosis (an increase in the number of white blood cells) that may be present in the acute phase
• Increased erythrocyte sedimentation rate and reactive C protein occasionally exist.
• The obvious cause in the mouth (usually) is like a decayed tooth.
• Teeth are gentle on percussion, which can develop as the condition progresses
• Loosen teeth, which can develop as the condition develops.
• Pus can then be seen, which radiate from around the neck of the tooth, from the open socket, or from other sites in the mouth or in the skin over the involved bone.
• Smell of amniotic.

Unlike acute OM of long bones, the acute OM of the jaw only gives a moderate systemic reaction and the person remains surprisingly good. OM acute on the jaw may provide a similar appearance to typical odontogenic infections, but cellulitis does not tend to spread from the periosteal envelope of the involved bone. If the infection is not controlled, the process becomes chronic and systemic symptoms are usually present, including drying of the fistulas, loosening teeth and sequestra formation. Untreated chronic osteomyelitis tends to have occasional acute exacerbations.

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Cause

OM is usually a polymicrobial, opportunistic infection, primarily caused by a mixture of alpha hemolytic streptococci and anaerobic bacteria from the oral cavity such as Peptostreptococcus, Fusobacterium and Prevotella , ( different from OM from long bones, usually caused by isolated Staphylococcus aureus infection). This is similar to the common causative organism in odotonogenic infections. However, when OM in the jaw follows trauma, the probable cause is still staphylococcal (usually Staphylococcus epidermis .

Other risk factors can be family hypercoagulation trends, including eg, Factor (5) Leiden heterozygosity.

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Pathogenesis

OM may occur either due to the spread of adjacent infection areas or by seeding infections from non-adjacent sites through the blood supply (hematogenous spread). Unlike OM of long bones, hemoglobin OM in jaw bone is rare. OM of the jaw is mainly due to the spread of adjacent odontogenic infections. The second most common cause is a traumatic fracture, usually in the mandible and is usually followed by a compound fracture (ie communicating with the mouth or external environment). In long-bone OM, one attacking microorganisms microorganisms are usually found (usually staphylococci spp.).

Mandibles are more commonly affected than upper jaws. This is thought to be related to the difference in the blood supply between the mandible and the maxilla. Maxilla has a better blood supply, and has thin cortical plates and fewer medullary chambers. These factors mean that the upper jaw infection is not easily confined to the bone, and easily removes edema and pus to the surrounding soft tissues and paranasal air sinuses. OM of the maxilla may be uncommon during uncontrolled middle ear infections or in infants with birth injury due to forceps. The mandible, in contrast, has a relatively poor blood supply, which worsens with age. The cortical plate is thick and there is a medullary cavity. The mandibular sites most often affected by OM are the (decreasing frequency) of the body, the symphysis, the angle, the ramus and finally the condyle. Mandibular blood supply mainly through the inferior alveolar artery, and the second through the periosteum. This supply compromise is an important factor in the development of OM in the mandible.

Most periapical and periodontal infections are isolated by the body resulting in a protective pyogenic membrane or abscess wall to keep the infection area localized. Micro-organisms that are virulent enough to destroy this barrier. Factors that may contribute to this are decreased host resistance, repeated operation or repeated fracture segments, which can occur with untreated fractures. Mechanical trauma polishes bone, causing ischemia by destroying blood vessels and seeds of micro-organisms into the tissues.

Events that precede OM are acute inflammatory changes such as hyperemia, increased capillary permeability and granulocyte infiltration. The proteolytic enzyme is released, and the formation of thrombus in blood vessels and tissue necrosis occurs. Pus accumulates in the bone medullary chamber, which increases pressure and causes blood vessel collapse, venous stasis and ischemia. The pine may also spread to the periosteal sub-layer, dissecting it away from the surface of the bone and further reducing the blood supply. Inferior alveolar neurovascular bundles are compressed in the mandible, causing anesthesia or paresthesia in the distribution of the mental nerves. Pus can flow through the sinuses on the skin and inside the mouth, and this may in time become lined with the epithelium, when they are called fistulas.

Chronic OM is characterized by healing rates that occur as lower levels of inflammation are present. New granulation and blood vessel tissue is formed, and necrotic bone fragments (sequestra) are separated from the vital bone. Small parts of necrotic bone can be absorbed entirely, and larger segments can be surrounded by granulation and new bone (involucrum) tissue. Sequestra can also be revascularized by new blood vessels, causing no symptoms or becoming chronically infected. Sometimes involucrum is penetrated by the channel (cloacae) through the pus that flows into the skin or mouth.

OM of jaw usually occurs in the presence of one or more predisposing factors. These factors are associated with compromised vascular perfusion locally, regionally or systemically, cause immunocompromise and poor wound healing. Specific examples including hiperagulasi family, diabetes, autoimmune diseases, agranulocytosis, leukemia, severe anemia, syphilis, chemotherapy, corticosteroid therapy, sickle cell disease, immunodeficiency syndrome acquired, advanced age, malnutrition, smoking and alcohol consumption, radiation therapy, osteoporosis, Paget's disease. bone, fibrous dysplasia, malignancy of the bone and cause bone necrosis such as Bismuth, mercury or arsenic. Poor compliance or access to health care is also a risk factor.

Rarely, OM of the jaw may be a complication of trigeminal herpes zoster.

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Prevention

Regular assessment and dental and periodontal care.

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Treatment

The culture and sensitivity of the wound site determine the choice of antibiotics. Repeated culture testing and sensitivity are often performed on OM because treatment is prolonged and antibiotic resistance may occur, when changes in the drug may be necessary.

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Prognosis

A mandibular pathological fracture is a possible complication of OM in which the bone has weakened significantly.

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Epidemiology

OM of the jaw usually occurs in adult men. Mandibles are more commonly affected than upper jaws. The most common cause of OM is the spread of adjacent odontogenic infections. The second most common cause is fracture, usually on the mandible.

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References

Source of the article : Wikipedia