Osteomylitis

it is inflammation of the bone involving bone marrow .

OSTEOMYELITIS

CLASSIFICATION OF OSTEOMYELITIS

1.Suppurative : -Acute suppurative OM -Chronic suppurative OM 2.Chronic sclerosing: -Focal sclerosing OM. -Diffuse sclerosing OM. -Chronic OM with proliferative periostitis 3.Special types: -Radiation OM -Chemical OM -Osteomyelitis of new borne Infants.

Acute suppurative OM

The source of infection usually being: 1.Teeth (dental abscess) 2.Local trauma (e.g fracture ,penetrating wound and extraction 3.Acute pericoronitis and ANUG. 4.Fracture line passing through infected periodontal pocket .

The microorganism most often implicated are: S.Aureus and S.albus or Streptococcus or could be mixed infection. Mandible affected >the maxilla Predisposing factors to infection may be present such as :
Predisposing factors To osteomyelitis
(Reduction in immunity Like Diabetes mellitus Leukemia Agranulocytosis
Reduction in blood supply) Like :PostradiationOsteopetrosisPaget’s disease

Pathogenesis of Osteomyelitis

Clinical feature of Acute suppurative OM
Pain ,Swelling , Parasthesia of the lip ,Pyrexia , Lymphadenopathy, Leukocytosis and mobility of the teeth if they are involved , Trismus is frequent, Pus may track through the cortical bone and soft tissue to discharge through a sinus .


Radiographic feature of Acute suppurative OM
May be normal in the early stages of the disease .But after 10 -14 days sufficient bone resorption may have occurred to produce irregular ,moth – eaten area of radiolucency

Histological feature of  Acute suppurative OM

The medullary space filled with inflammatory exudate ,the inflammatory cells are chiefly neutrophil (PMNL) but may show occasional lymphocyte and plasma cell .the osteoblast bordering the bone trabeculae are generally destroyed depending upon the duration of the process ,the trabeculae may lose their viability and begin to undergo slow resorption

Histological feature of  Acute suppurative OM

sequestrum

Treatment of  Acute suppurative OM

1. Incision & Drainage. 2.Infection treated with antibiotic . 3.Analgesic . 3.Surgical removal of large sequestrum .

Chronic suppurative osteomyelitis 

This may develop from acute or may be chronic from the onset .the clinical feature are less sever than the acute type Acute exacerbation may arise periodically and may be associated with pus and sequestrum formation

Chronic suppurative osteomyelitis 

Marrow space contain chronically inflamed granulation tissue ,excessive bone resorption may occur ,it may contain pocket of pus and sequestrum


Chronic focal sclerosing osteomyelitis
Localized areas of bone sclerosis Associated with the apices of teeth with pulpitis (from large carious lesions or deep coronal restoration )or pulpal necrosis are termed condensing osteitis .it arise either due to low grade infection or high tissue resistance

Clinical feature of CFSO

Seen most frequently in children and young adults .Associated with the apex of a tooth with dental pulp demonstrate pulpitis or necrosis .clinical expansion should not present .most cases occur in premolar and molar area of the mandible .

Radiographic feature  of CFSO

There is increase in radiodensity of the bone adjacent to the apex of the affected tooth .But the outline of the involved tooth is visible.

Histopathological feature of CFSO

A localized increase in the number and thickness of the bone trabeculae is seen .there may be scattered lymphocyte and plasma cells in the surrounding scanty fibrosed marrow

Treatment of CFSO

1. Endodontic therapy 2.extraction.

Chronic diffuse sclerosing osteomyelitis (CDSO)

This condition represent a proliferative reaction of bone to low grade infection and the portal of entry is believed to be through diffuse periodontal disease

Clinical feature of (CDSO)

Arises almost exclusively in adulthood ,it’s primarily occurs in the mandible .specially around sites of chronic infection like periodontitis, pericoronitis and apical inflammatory disease and radiodensity may extend to an entire quadrant. Pain and swelling are not typical. But there is an acute exacerbation of the chronic infection this result in mild suppuration .


Radiographic feature of (CDSO)
Diffuse sclerosis of the bone with radiolucent rims or zones or appear as sclerotic nodules with ill defined border, described as cotton- wool appearance .

Histopathology of (CDSO)

Show dense ,irregular trabeculae of bone .some of them are bordered with active layer of osteoblast , focal area of osteoclasts activity are some time seen ,the bone in some lesions show pronounced mosaic appearance indicated of repeated process of bone resorption and repair .bone marrow is fibrosed and containing chronic inflammatory cells.

Treatment of (CDSO)

Surgical removal is difficult because the lesion is diffused .it’s best treated by resolution of foci of infection .as the sclerotic bone is hypovascular it sensitive to infection and when infection occur the treatment required is as for acute osteomyelitis

Chronic osteomyelitis with proliferative periostitis or periostitis ossificans or Garre’s osteomyelitis Bone formation within a periosteal reaction is a common finding occurs in a wide variety of intraosseous pathosis. Common causes of periosteal bone formation are osteomyelitis , trauma, cysts and neoplasm .

Clinical featureof Garre’s osteomyelitis The patients are primarily children and young adult ,the most frequent cause is dental caries with associated periapical inflammation ,most cases arise in premolar and molar area of the mandible (mostly buccal cortical plate ) appear as rocky hard swelling

Radiographic featureof Garre’s osteomyelitis Occlusal radiograph show focal overgrowth of bone on the outer surface of the cortex ,which may be described as a duplication of the cortical plate of the bone or described as onion –skin appearance

Histopathological featureof Garre’s osteomyelitis There are parallel rows of highly cellular and reactive woven bone in which the individual trabeculae are frequently oriented perpendicular to the cortex .between the cellular trabeculae ,relatively uninflamed f.c.t is evident .

Treatment of Garre’s osteomyelitis treatment is carried out to eliminate the infection either by extraction or endodontic therapy Remodeling of bone may take between 6 -12 months .


Osteoradionecrosis

Osteoradionecrosis