Osteomyelitis in the head and neck

Government of Karnataka, India, Bengalūru, Karnataka, India
Acta Oto-Laryngologica (Impact Factor: 0.99). 03/2007; 127(2):194-205. DOI: 10.1080/00016480600818054
Source: PubMed

ABSTRACT All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predisposing conditions. Current radiological tools are sufficient to provide adequate diagnosis. Treatment can be conservative resection of the diseased bone with adequate clearance in all cases except in cases of osteomyelitis due to osteoradionecrosis (ORN) where resection has to be more radical.
In today's antibiotic era, osteomyelitis in the head and neck is a rare occurrence. Dealing with osteomyelitis in head and neck bones is not the same as in other bones of the body due to the nature of the bones, complex anatomy of the region, and esthetics. Our purpose was to analyze the behavior of osteomyelitis in the head and neck bones and its management.
A total of 84 cases of osteomyelitis in head and neck were reviewed in a 10-year period. Pus for culture, antibiotic sensitivity, and radiology were the main investigations. A medical line of treatment was effective in acute cases. Surgery was opted for in chronic cases.
Mandible, frontal bone, cervical spine, maxilla, temporal bones, and nasal bones were involved, in descending order of frequency, i.e. the mandible was the most common bone affected. Nine patients were diagnosed as having acute osteomyelitis (11%); 75 were diagnosed as having chronic osteomyelitis (89%). Radiation-induced ORN leading to osteomyelitis was the most common cause of osteomyelitis of the mandible (13 of the 32 cases; 41%). Odontogenic infections and chronic sinusitis each gave rise to osteomyelitis in 3 of 10 cases (30%) of the patients with osteomyelitis of the maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in all 20 cases (100%). Tuberculosis (10 of 15 cases; 67%) and malignancy (5 of 15 cases; 33%) were the main predisposing factors in cervical spine osteomyelitis. Malignant external otitis (MEO) with diabetes mellitus was an underlying factor in all four cases of osteomyelitis of the temporal bone. Of the 18 patients with a diagnosis of ORN, the mandible was found to be the most susceptible bone (13 cases; 72%), followed by the maxilla (four cases; 22%) and cervical spine (1 case). Acute osteomyelitis responded to antibiotics. Sequestrectomy was carried out in all chronic cases but in cases of ORN more radical surgery was performed.

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    • "Chronic osteomyelitis may represent the long-term sequela of untreated acute osteomyelitis or a continuing, low-grade inflammatory response, which never went through a substantial or clinically evident acute phase [10]. Although there are reports of chronic osteomyelitis in the jaws [2] [11], cases occurring in the maxilla are rare, as are extensive lesions [12] [13]. "
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    ABSTRACT: Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.
    12/2014; 2014. DOI:10.1155/2014/930169
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    • "For microbial diagnosis of chronic osteomyelitis, only bone biopsy, bone sequestra, bone marrow, granulation tissue and aspirated pus specimens are acceptable for microbial diagnosis. In order to avoid cross-contamination from oral microorganisms, the clinical specimens must be collected by surgical procedures, avoiding contact with oral tissues, oral environment and sinus tracts (Prasad et al., 2007). When bone biopsies were removed, areas of the margin of the osteolytic lesion must be preferred. "
    09/2010; 4(2):197-202. DOI:10.4067/S0718-381X2010000200015
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    ABSTRACT: Objectives: To study bony complications of sinonasal disease and its varied manifestations. Methodology: In this five year retrospective study, cases with bony complications from 2003 to 2007 were collected and their records evaluated. Twenty cases were identified with bony complications. Results: Maxilla was most common bone affected. Five patients were diagnosed as having acute osteomyelitis (35%); an equal number were diagnosed as having chronic osteomyelitis of which one had a fistula on the cheek and one had fistula due to tuberculosis. Odontogenic infections and chronic sinusitis each gave rise to two cases with osteomyelitis of the palate and maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in two cases, one of which had a discharging fistula in left frontoethmoid region displacing eye. Fungal sinusitis led to destruction of lamina papyracea. Acute osteomyelitis responded to antibiotics. Conclusions: Polymicrobial infection is common, antibiotics are indicated initially. Surgery is considered when an abscess is revealed by CT and if it deteriorates clinically. Results suggest that FESS is effective for diagnosis and treatment of complications but can be combined with conventional surgery which is effective in management of refractory sinusitis.
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