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Adekeye EO, Cornah J. Osteomyelitis of the jaws: a review of 141 cases. Br J Oral Maxillofac Surg 1985;
Abstract
A survey of 141 cases of osteomyelitis of the jaws is presented. The salient clinical features, the aetiology and treatment of the lesions are described. A high incidence of the disease in the maxilla is noted. Lesions of the maxilla mainly occurred in patients in the first decade of life, whilst those of the mandible affected individuals in the third decade. The possible relationship between infection, blood supply to the jaw bone, and associated debilitating conditions is examined.
... only 2 patients (1.42% of the study population) had involvement of the malar bone. [3] There now is however a noticeable increase in the number of patients presenting with zygomatic osteomyelitis secondary to CAM, a phenomenon which is highlighted in the following case series. It should be noted that there are no structured studies in the literature highlighting the incidence of CAM infection involving the zygomatic bone. ...
... Osteomyelitis of the maxilla is extremely rare. [3] Osteomyelitis occurring due to fungal infection was rare and occurs in an indolent manner. Osteomyelitis is more commonly seen in males (80.36%) than in females (19.64%), with a peak incidence in 30-39 years of age [4]. ...
... Adekeye et al. published a review of 141 cases of osteomyelitis of the jaws and reported the incidence of malar bone osteomyelitis to be only 1.42% [3]. The incidence of zygomatic bone osteomyelitis reported in our study of cases with CAM is 8.6%. ...
AimTo highlight the incidence of osteomyelitis due to CAM and to elucidate the mode of spread of infection from maxilla to zygomatic bone, to highlight how that is distinct from other cases of zygomatic osteomyelitis due to other etiologies.MethodsA standard protocol of treatment of the cases of CAM with zygomatic involvement based on our own outcomes was furnished. All 10 patients were treated with dual antifungal therapy and aggressive surgical resection via extraoral approach, in conjunction with functional endoscopic sinus surgery (FESS).ResultsTen out of 116 patients of CAM reporting to our institute presented with zygomatic bone involvement with an incidence rate averaging at 8.6%, whereas in previous literature osteomyelitis of zygomatic bone was extremely rare with an incidence pattern of just 1.42%.Conclusions
The treatment protocol followed by the authors gave good outcomes to all patients treated, with no mortalities.
... 4,5 Furthermore, previous studies have examined the occurrence of different chronic inflammatory conditions in the orofacial region either as a series or as case reports on interesting findings. [6][7][8][9] Gaetti-Jardim Jr et al. discussed their management of patients with jaw chronic osteomyelitis in Brazil, emphasizing the role of anaerobic organisms in its aetiology as well as its susceptibility to blactams and clindamycin. 6 Similarly, Adekeye and Cornah reviewed 141 cases of chronic osteomyelitis of the jaws in a Nigerian population, noting a preference for the maxilla in the first decade of life. ...
... 6 Similarly, Adekeye and Cornah reviewed 141 cases of chronic osteomyelitis of the jaws in a Nigerian population, noting a preference for the maxilla in the first decade of life. 7 Moreover, Sezer et al. reported four cases of actinomycotic tuberculosis (TB) occurring in three women and a man in Turkey, equally affecting the maxilla and mandible, 8 while Rattan and Rai also highlighted the management of extra pulmonary TB in a few Indian patients. 9 Conversely, there is a dearth of studies appraising the occurrence of all chronic inflammatory diseases in the jaws and orofacial region. ...
... 22 Similarly, Daramola and Ajagbe had earlier reported 34 cases of chronic osteomyelitis, 24 while Adekeye and Cornah reviewed 141 cases based on clinical features. 7 In addition, Singh conducted a prospective study of 21 cases of chronic suppurative osteomyelitis. 23 In this study, chronic osteomyelitis constituted 30.5% of chronic inflammatory lesions of the jaws and 1.4% of all biopsies over the study period, which is less than what was obtained in other studies. ...
BACKGROUND: Chronic inflammation is a persistent inflammation characterized by tissue repair which may occur around the jaws due to varying causes. This study aims to review its clinico-pathologic features.
METHODS: The study location was the Oral Pathology Laboratory, University College Hospital (UCH), Ibadan, Nigeria. Archival records were examined and all entries made as histopathological diagnosis of a chronic inflammatory lesion were identified and included in the study. The clinical data regarding age, gender, site of lesion, clinical diagnosis, and histopathological diagnosis were extracted from the histopathology reports of the patients. Data were presented using summary statistics and analysed with the SPSS software. Chi-square test was used to test the association between age, gender, and histopathological diagnosis. Statistical significance was set at P < 0.050.
RESULTS: Orofacial lesions diagnosed as chronic inflammatory lesions were 95, constituting 4.6% of 2046 diagnoses made. They occurred mostly in the 21-40 years age group recording 34 (35.8%) of cases. The mean age of men was 36.6 ± 19.0 years, while for women was 49.0 ± 21.5 [t = -2.82, degree of freedom (df) = 95,
P = 0.006]. Women were more affected while the mandible was the most commonly affected site, making up 43.2% of cases. Non-specific chronic inflammation was the most frequently diagnosed lesion constituting 32.6% of cases followed by chronic osteomyelitis constituting 30.5%.
CONCLUSION: Summarily, chronic inflammatory lesions are rarely seen around the jaws and orofacial region. Larger studies on these rare lesions are advocated to further assess their prevalence globally.
... Frühsymptome, welche in diesem Kontext besonders relevant sind, sind das ödematöse Anschwellen der Mukosa im Bereich der Wurzelspitzen, eine mögliche Eiterentleerung aus der Zahnfleischtasche, ein als "dumpf" zu beschreibender Klopfschall des betroffenen Kieferabschnitts, Zahnlockerungen, Kieferklemme und Sensibilitätsstörungen des Nervus alveolaris inferior sowie des Nervus mentalis (i.e. Vincent-Symptom; [2,25,26]). ...
... Neben der klinischen Symptomatik können verschiedene bildgebende Verfahren für die Diagnose eingesetzt werden. Neben Blutuntersuchungen und konventioneller Röntgendiagnostik kommt heute der Computertomographie, Positronenemissionstomographie, Magnetresonanztomographie und auch der Knochenszintigraphie wesentliche diagnostische Bedeutung zu [1,11,17,25,[27][28][29]. Welches Diagnostikum gewählt wird, ist individuell zu entscheiden und unter anderem abhängig von Klinik, Verlauf und Differenzialdiagnosen [11,25]. ...
... Neben Blutuntersuchungen und konventioneller Röntgendiagnostik kommt heute der Computertomographie, Positronenemissionstomographie, Magnetresonanztomographie und auch der Knochenszintigraphie wesentliche diagnostische Bedeutung zu [1,11,17,25,[27][28][29]. Welches Diagnostikum gewählt wird, ist individuell zu entscheiden und unter anderem abhängig von Klinik, Verlauf und Differenzialdiagnosen [11,25]. ...
Osteomyelitis is a severe disease caused by the invasion of pathogens into the osseous marrow cavity. Depending on the pathogen spectrum, localization and stadium, the clinical presentation and course of the disease can be very heterogeneous. Before the antibiotics era, the mortality among patients with acute forms of osteomyelitis was approximately 50 %. Nowadays, the main problem is chronic infections due to multi-drug resistant pathogens, which can have far-reaching consequences for patients, e.g. prolonged systemic antibiotic therapy and multiple surgical interventions up to amputation of a limb. Due to this, osteomyelitis is the subject of extensive research.
This article gives a comprehensive review of this topic with particular emphasis on the current scientific developments with respect to chronic osteomyelitis, osteomyelitis in angiopathy and the various special forms of osteomyelitis.
... Osteomyelitis is an inflammatory condition of bone involving the medullary cavity, the haversian systems and the adjacent cortex, being a rare disease nowadays (Nitzan and Marmary, 1982;Adekeye and Cornah, 1985). Hence, whenever one suspects of such pathology, the possibility of immunosuppressive conditions or underlying bone pathology should be suspected (Nitzan and Marmary, 1982;Adekeye and Cornah, 1985;Barry and Ryan, 2003;Barry et al., 2007). ...
... Osteomyelitis is an inflammatory condition of bone involving the medullary cavity, the haversian systems and the adjacent cortex, being a rare disease nowadays (Nitzan and Marmary, 1982;Adekeye and Cornah, 1985). Hence, whenever one suspects of such pathology, the possibility of immunosuppressive conditions or underlying bone pathology should be suspected (Nitzan and Marmary, 1982;Adekeye and Cornah, 1985;Barry and Ryan, 2003;Barry et al., 2007). In the osteopetrotic patient, granulocytopenia may be one predisposing factor to this infection. ...
... It is known that radiographic evaluation is not as sensitive as the CT scan (Schuknecht et al., 1997), consequently CT scanning is mandatory. Adekeye and Cornah (1985) reviewed 141 cases of osteomyelitis in non-osteopetrotic patients and stated that resection of the affected bone should be carried out only where the lingual and buccal cortical plates were destroyed by the osteomyelitis without any evidence of new bone formation. Suey et al. (1997) reported on the treatment of four cases of diffuse sclerosing osteomyelitis and claimed that mandibular resection should be limited to severe, therapy-resistant cases and that the extent of the resection should be established more carefully using other diagnostic tools such as technetium bone scan, computed tomography and magnetic resonance imaging before the operation. ...
Osteopetrosis (OP) is a rare hereditary disorder characterized by a dysfunction of the osteoclasts that impairs bone resorption, which together with the normal osteoblastic activity forms intense bone sclerosis with reduction of marrow. A common complication that arises, most frequently, as a result of tooth extraction is mandibular osteomyelitis. There is no consensus on the literature about the treatment of this infection in an osteopetrotic patient, therefore, the purpose of this paper is to report a case of marginal resection for treatment of mandibular osteomyelitis in an osteopetrotic patient and discuss relevant features of this procedure.
... [75,76] In a review of 141 cases of jaw osteomyelitis in Nigeria, Adekeye, and Cornah found OIs to be the cause of 38% of mandibular and 25% of maxillary involvement. [77] Pain and tenderness, low-grade fever, draining sinus tracts, suppuration, dental loss, and sequestrum (i.e., necrotic bone fragment) formation are main clinical features. New bone and oral mucosa occasionally regenerate beneath the sequestra, probably because of activation of periosteal osteoblasts by the infectious process. ...
... New bone and oral mucosa occasionally regenerate beneath the sequestra, probably because of activation of periosteal osteoblasts by the infectious process. [77] Wang et al. described the first case in which recurrent vertebral osteomyelitis and psoas abscess developed in a patient with a previously unrecognized atrial septal defect and disease recurrence was ascribed to the presence of dental disease, which served as the source of infection. [78] On radiographs, osteomyelitis appears as radiolucent ("moth-eaten") regions representing bony destruction and avascular necrosis, with evidence of sequestrum formation and occasional pathologic fractures. ...
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."
... Clinically, osteomyelitis is associated with boné infection. It generally begins in the medullary cavity and spreads to the cancelous boné, boné córtex and eventually the periosteum 13 . The bacterial invasion of the cancelous boné causes inflammation and edema of the medullary spaces, which will result in compression of the boné blood vessels and serious impairment of blood supply. ...
... Besides the microbial factor, some predisposing conditions may be associated: malnutrition, malária, anemia, measles 13 , diabetes mellitus, chronic hypoxia, autoimmune diseases, venous stasis, diseases of the large vessels, such as arteritis, fibrosis by radiation, small vein pathology n and any other factors that may lead to immunodepression. ...
... 1955 berichteten Pell et al. (1955) über eine derartige Erkrankung im Unterkiefer. In den Kieferknochen ist die Mandibula deutlich häufiger betroffen als die Maxilla (Adekeye & Cornah 1985). Nur bei Säuglingen und Kleinkindern unter zwei Jahren überwiegt die Lokalisation im Oberkiefer. ...
Knochenentzündungen entstehen entweder nach Infektion des Knochens durch pathogene Keime oder seltener abakteriell, beispielsweise durch physikalische Reize. Die primär chronische Os teomyelitis der Mandibula ist eine Entzündung des Knochens ohne klare Ätiologie und akute Vorphase. Symptome treten periodisch episodenhaft über wenige Tage bis mehrere Wochen in verschiedenen Intensitäten auf. Die Patienten leiden unter Schmerzen, Schwellung, Kiefer klemme, lokalisierter Lymphadenitis und Sensi bilitätsstörungen. Als zuverlässige Suchmethode einer Osteomyelitis wird die knochenszintigra fische Untersuchung mit radioaktiv markierten Nukliden eingesetzt. Die Therapie beinhaltet länger andauernde hochdosierte antibiotische Therapie, hyperbare Sauerstofftherapie und chi rurgische Sanierung, die Debridement und Dekortikation bis Resektionschirurgie umfassen kann. In neuester Zeit wurden sogar mittelfristig erfolg reiche Bisphosphonatbehandlungen beschrieben. Im folgenden Fallbericht wird über eine in der Mandibula lokalisierte primär chronische Osteomyelitis eines zehnjährigen Knaben berichtet. Klinische und radiologische Merkmale sowie Diagnosestellung, Therapie und Nachsorge werden dokumentiert und anhand der vorliegenden Literatur diskutiert.
... Osteomyelitis in zygoma and maxilla is a rare occurrence as compared with mandible due to rich vascularity and thinner cortices that promote rapid healing. 1 Characteristic features include bone destruction with sequestrum formation, formation of extraoral sinuses and facial disfigurement. We presented a case of chronic suppurative osteomyelitis of bilateral zygoma which was fungal in origin. ...
Zygomatic osteomyelitis is a rare occurrence due to rich collateral blood supply of bone. A man in his 30s presented with complaints of pain over bilateral cheek and pus discharge below the eye on lateral aspect. He was a known case of COVID-19 associated mucormycosis postendoscopic debridement of sinuses 3 months back. Radiology revealed bilateral destruction of zygoma with discharging sinus. Microbiological analysis confirmed aseptate hyphae in pus, and a diagnosis of bilateral fungal zygomatic osteomyelitis made. Under general anaesthesia, sequestrectomy done using bilateral lateral rhinotomy with extended Dieffenbach’s approach (batwing incision). Postsurgery 3000 mg of liposomal amphotericin was administered. There was no enophthalmos or restricted eye movements postoperatively. Follow-up MRI suggested minimal inflammatory enhancement in maxillary sinus. Patient was discharged on oral antifungals.
... Osteomyelitis (OML) of maxilla is very rare due to its rich collateral blood supply, thin cortical plates. 1 It is caused most commonly by Staphylococcus aureus, epidermidis, Actinomyces and Escherichia coli. 2 In the literature, the OML of malar bone is only 1.42% and OML of frontal sinus is extremely rare. 3 We here in describe a case with OML of right maxilla extending to maxillary sinus, lateral nasal wall, zygomatic bone and inferior and medial orbital wall up to frontal sinus. The extension of OML to frontal sinus and zygomatic bone via maxillary bone is very rare; the present case described the successful management and early intervention. ...
A 52-year male patient reported with loosening of right upper jaw. He has no pain or discharge, or any acute symptoms and systemic disease. Intraoral examination reveals necrosed maxillary bone. He also has no sickle cell disease, hepatitis, HIV or tuberculosis. 3D CT scan reveals destruction of maxilla, maxillary sinus, lateral nasal wall, superior and inferior orbital wall, zygoma and frontal bone(outer table). The clinical diagnosis of osteomyelitis was made. Under general anaesthesia, sequestrectomy was done with the help of Weber-Ferguson incision with infraorbital extension for maxilla, maxillary sinus, zygomatic bone, lateral nasal wall and infraorbital and medial wall of orbit. Frontal sinus region sequestrectomy was done via bicoronal flap. The patient was completely diseased free after 4 years follow-up.
... Infections of the jaw bones can occur following dental caries, traumatic injuries, surgery, and local infections such as sinusitis and via hematogenous spread in the context of infectious general diseases. Whereas most infections with a dental focus lead to a localized process such as abscessation, the infection in a minor number of cases spreads in a more diffuse manner resulting in osteomyelitis [1][2][3]. This entity is defined as infection of the bone and marrow and has been described by several authors who have suggested various classification systems [4][5][6][7][8]. ...
Objectives
Bacterial osteomyelitis of the jaw is a severe disease potentially requiring extensive surgical treatment. We have evaluated the incidence rates of bacterial osteomyelitis following dental abscessation associated with primary or secondary tooth extraction.Materials and methodsA retrospective cohort study was designed and included patients with dental abscesses and surgical treatment including the extraction of focus teeth. Patients were either treated with primary removal during acute infection or secondary delayed extraction within an infection-free interval. The primary outcome variable was the occurrence of bacterial osteomyelitis following the abscess. Secondary outcomes were the influence of general disease, antibiotic therapy, and surgical technique.ResultsOne hundred nine patients were enrolled in the study; 4 patients (3.7%) developed osteomyelitis. Primary tooth extraction was performed on all these patients (p = 0.017). Significant associations of diabetes (p = 0.001), the use of clindamycin (p = 0.025), and transcutaneous incision (p = 0.017) with the incidence of osteomyelitis were detected.Conclusions
More severe infections may be associated with a higher risk for the development of osteomyelitis following dental abscesses. A history of diabetes and clindamycin therapy might form further predisposing risk factors. Because of the low incidence and the small case number, our data need to be interpreted carefully.Clinical relevanceOsteomyelitis of the jaw is a rare but severe disease that may require extensive therapy and that impairs the quality of life of affected patients. The evaluation of risk factors to enable further reduction of incidence is therefore urgently required.
... Bacteria isolated from osteomyelitis caused by infection are often associated with the patient's age or trauma and recent surgery [1]. The main etiology is bacteria's presence in oral cavity [2]. Stapylococcus aureus is the most common cause of acute and chronic osteomyelitis but osteomyelitis is also associated with many other pathogenic bacteria [3,4]. ...
... In healthy individuals, such as our patient, osteomyelitis is an extremely uncommon infectious complication because intact host immunity is able to localize and limit disease spread by forming protective pyogenic membranes and abscesses. 3 The lack of dental caries or another clear source of infection in our patient also made this diagnosis less likely. ...
... Conversely, the authors of a Japanese study [58] reported that CODs more frequently affect men of more advanced ages and hormonal factors were suggested to be associated with sex predilection. As regards osteomyelitis of the jaws, individuals of any age may be susceptible and a slight male predilection exists [59]. Based on the findings of the present case series, women seem to be more likely to develop infection occurring within a lesion of COD than men. ...
The aim of this study was to describe a series with 66 cases of infected cemento-osseous dysplasia (COD) and to discuss the demographic distribution, clinicoradiographic features and treatment of this condition. A study looking back on the diagnoses made at a single Brazilian centre within a 28-year timeframe was performed. A literature review with searches across five databases was also conducted to identify reports on osteomyelitis/infected COD. Descriptive and statistical analyses were performed. The case series study showed a female/male ratio of 21:1. Affected individuals’ mean age was 57.4 years. Mandible was the most affected site (95.5%) and florid subtype was the most frequent infected COD (62.1%). Tooth extraction was the main factor associated with the development of infection associated within a COD lesion. The literature review retrieved 30 studies reporting 46 cases of this condition. Asian women in their 40 s and 50 s were more affected. Surgery for removal/curettage of necrotic bone was acknowledged as an appropriate approach to the treatment of this infection. The clinicodemographic data of the study were similar to data collected across the literature. Clinicians, maxillofacial surgeons and oral rehabilitation providers should be alert to the diagnosis of COD, since infection is a frequent complication whose management is challenging.
... In some pockets, Scheduled Castes populations e.g. Jharia, Mehra, Dahariya etc. have very high prevalence of sickle haemoglobin i.e. over 30 percent 10 . Co-inheritance of β-thalassaemia gene alongwith gene for sickle haemoglobin also causes sickle cell disease 11 . ...
... Osteomyelitis caused by sinusitis occurs frequently in the frontal bone and rarely in the maxilla as the maxilla has relatively well-developed vascularity and a thin bone structure 6 . However, these features can allow the lesion to spread to the surrounding soft tissue and the sinuses 7,8 . ...
Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment.
... Radiographically, CFSO typically presents as a periapical radiopaque mass of sclerotic bone, which could be either well circumscribed or ill defined and blending into adjacent normal bone. 15 W hen mixed radiopaque and radiolucent lesions involve the periapical region of nonvital teeth, CFSO should be included in the differential diagnosis. Histopathological analysis of CFSO reveals chronic inflammation along with thickened bony trabeculae, with or without fibrosis. ...
This article describes 3 patients, each of whom presented with an asymptomatic mixed radiopaque and radiolucent lesion of the maxillary sinus associated with a nonvital tooth. Based on the radiographic findings, a diagnosis of a collapsed (ruptured) radicular cyst was rendered in each case. A tissue biopsy was performed in 1 case, and the results supported the diagnosis. The radiographic and histopathological features, etiology, pathophysiology, and radiographic differential diagnosis of this condition are discussed.
... 1955 berichteten Pell et al. (1955) über eine derartige Erkrankung im Unterkiefer. In den Kieferknochen ist die Mandibula deutlich häufiger betroffen als die Maxilla (Adekeye & Cornah 1985). Nur bei Säuglingen und Kleinkindern unter zwei Jahren überwiegt die Lokalisation im Oberkiefer. ...
Inflammation of bone is caused either by bacterial infection or occasionally by physical stimulus. Primary chronic osteomyelitis of mandibular bone is a chronic inflammation of an unknown cause. Pain, swelling, limited mouth opening, regional lymphadenopathy and hypaesthesia are clinical symptoms at initial presentation. Results of biopsy, computed tomography and scintigraphy reveal the diagnosis of a primary chronic osteomyelitis. Its management is long-term antibiotic therapy, hyperbaric oxygen and surgical therapy, even bisphophonate treatement may be a good option. The case report presents a primary progressive chronic osteomyelitis of the manibular bone of a ten year old boy. Clinical and radiological signs are discussed as well as diagnosis, management and follow-up.
... We suggest that the high female predominance in our study may imply delayed dental care in female patients due to sociocultural dependence of the females on their husbands for consent and financial support for treatment in our environment. An earlier Nigerian study on jaw osteomyelitis had reported that all patients generally presented late in the natural history of the condition (22). The adult predilection and mandibular involvement is in agreement with a report by Yeoh et al. (23). ...
The mandible and maxilla can be the site of myriads of lesions that may be categorized as neoplastic, cystic, reactive and infective or inflammatory. Literature reviewing jaw swellings in an amalgamated fashion are uncommon, probably because aetiologies for these swellings are varied. However, to appreciate their relative relationship, it is essential to evaluate the clinico-pathologic profile of jaw swellings. The aim of this appraisal is to describe the array of jaw swellings seen at our hospital from 1990 to 2011, to serve as a reference database.
Biopsy records of all histologically diagnosed cases of jaw swellings seen at the department of Oral Pathology, University College Hospital between January 1990 and December 2011 were retrieved, coded and inputted into SPSS version 20. Data on prevalence, age, sex, site and histological diagnosis were analysed descriptively for each category of jaw swellings. All patients below 16 years were regarded as children.
A total of 638 jaw swellings were recorded in the 22-year study period. The Non Odontogenic Tumours (NOT) were the commonest, accounting for 46.2% of all jaw swellings. Odontogenic Tumours (OT) formed 45% of all adult jaw swelling while it formed 25.2% in children and adolescents. Ameloblastoma was the commonest while the most common NOT was ossifying fibroma (OF). Chronic osteomyelitis of the jaws was about 6 times commoner in adult females than males and mostly involved the mandible. The most common malignant jaw swelling was Burkitts' lymphoma (BL) that was about 7 times more in children than adults. Osteogenic sarcoma was the most common malignancy in adults.
Jaw swellings are extensively varied in types and pattern of occurrence. This study has categorized jaw swellings in a simple but comprehensive fashion to allow for easy referencing in local and international data acquisition and epidemiological comparison. Key words:Jaw swellings, odontogenic, Nigeria.
... Osteomyelitis caused by actinomycosis demonstrates intralesional gas from anaerobic breakdown or fistulas within the mouth, whereas mandibular osteomyelitis caused by other organisms does not typically result in fistulas or intral- esional gas. 12 MR imaging has higher accuracy in the detection of inflammatory and infiltrative changes in the surrounding soft tissue extending to the skin, 13 particularly in the muscles of mastication, though visualization of gas is challenging. Although bone marrow signal changes of MA were similar to osteomyelitis secondary to other causes, 13 very extensive soft tissue inflammatory and infiltrative changes in the surrounding soft tissues extending to the skin may be useful in the differentiation of actinomycosis from osteomyelitis due to other causes. ...
Mandibular actinomycosis is an uncommon disease. We retrospectively reviewed 6 patients with pathologically proven mandibular actinomycosis who underwent both CT and MR imaging to evaluate the characteristic imaging findings. CT results showed an irregularly marginated lesion with increased bone marrow attenuation, osteolysis, and involvement of the skin in all patients. Periosteal reaction and intralesional gas were seen in 4 patients. MR imaging results revealed low signal on T1-weighted and high signal on T2-weighted images of the mandible, and moderate heterogeneous enhancement was seen in all patients who received intravenous contrast. Cervical lymphadenopathy was not observed. Involvement of the masseter, lateral pterygoid, and medial pterygoid muscles was seen in 4 patients, whereas parotid gland and submandibular gland as well as parapharyngeal space involvement were seen in 3 patients. Familiarity with the imaging findings of mandibular actinomycosis may help to diagnosis this entity.
Osteomyelitis is the inflammatory condition known to affect the jaw bones as well as the long bones of the skeleton. In the facial skeleton, it commences in the medullary portion of the bones and extends further to involve the cortex and periosteum. The diagnosis of osteomyelitis is usually established on the basis of history, presenting clinical features, radiographic and histopathology findings. We present here three cases of osteomyelitis with atypical presentations. Usually in children and young adults, osteomyelitis of facial skeleton is not very common. In maxillofacial skeleton, however, when there are underlying systemic condition, children and young adults may present with osteomyelitis. In certain cases, they also do present as reactionary process in the bone or will have no underlying systemic condition. Diagnosing these cases and management often becomes challenging in the children and young adults.
Background:
Polymorphous low-grade adenocarcinoma (PLGA) is a slow growing malignant tumor of minor salivary glands and is generally of indolent nature. However, according to the most recent WHO Classification of Salivary Gland Tumors (2017), the cancer is classified as Polymorphous AdenoCarcinoma (PAC). PAC presents as a less aggressive tumor, though it could on rare occasions demonstrate distant metastasis. Case Presentation. A 47-year-old man who was referred by a private practitioner for a CBCT scan in reference to a proliferative soft-tissue growth in the hard palate. The growth was mild and tender and there was Grade III mobility in relation to all the maxillary teeth. Panoramic radiograph taken previously had revealed evidence of alveolar bone loss in relation to the maxillary teeth and was inconclusive of any other findings. The CBCT scan revealed evidence of moth-eaten appearance of maxilla with destruction of medial and lateral walls and floor of maxillary sinus. There was also evidence of involvement of right eustachian tube, ethmoidal wall, and nasopalatine canal. An intraosseous malignancy of the palate was suspected, and a total maxillectomy was performed. The tissue sample was sent for histopathological assessment wherein changes diagnostic for polymorphous low-grade adenocarcinoma of the palate were observed.
Conclusion:
PAC is a distinct, yet commonly occurring, minor salivary gland tumor with varied clinical and histologic appearance. This case report highlights the importance of CBCT in diagnosing the intraosseous involvement of such tumors which can help shed some light in enhancing our knowledge about the minor salivary gland malignancies like PAC.
Osteomyelitis of the jaws has become a rare disease since the introduction of antibiotics in clinical medicine. This chapter highlights the topic from the perspective of the infectious disease specialist, the microbiologist, and the maxillofacial surgeon. It utilizes “the Zurich classification system,” which has been proposed by Baltensperger and Eyrich. In the Zurich classification, it labels a heterogenous group of chronic inflammatory bone diseases, mostly of unknown etiology. The spectrum of microorganisms causing osteomyelitis of the jaws is much broader than the one in osteomyelitis at other localizations. The infecting agents differ among the different types of osteomyelitis, because of the various pathogenesis. There are several underlying conditions that can be considered risk factors for the occurrence of osteomyelitis of the jaws. The goals of osteomyelitis therapy of the jaws are focus eradication by meticulous debridement including removal of dead bone and unstable internal fixation devices, combined with correct empirical and pathogen‐directed antimicrobial therapy.
Background
Osteomyelitis of the jawbone is mostly secondary to radiation exposure or bone remodelling drugs, with the mandible being commonly involved. Maxillary osteomyelitis risk is low owing to its high vascularity. This study was undertaken to evaluate risk factors, presentation, management and outcomes of maxillary osteomyelitis caused due to reasons other than irradiation and bone remodelling drugs.
Methods
Patient records diagnosed with maxillary osteomyelitis were evaluated for demographic details, risk factors, clinical presentation, radiological features, treatment performed and outcomes.
Results
In 38 patients with non-irradiated and non-drug–induced osteomyelitis, 13 involved the maxilla, seven were localized to the posterior maxilla and 10 showed paranasal sinus involvement. Dissemination to the cavernous sinus and cerebral spread was seen in one. Clinical findings included oroantral communication, pain and draining sinus. Imaging showed diffuse bone destruction areas with or without evidence of bony sequestrum. The most common systemic risk factor was diabetes mellitus. Maxillary osteomyelitis was associated with tooth extraction in eight cases. Surgical management included debridement, sequestrectomy, functional endoscopic sinus surgery, maxillectomy and reconstruction of soft tissue defect with local and regional flaps. Complete recovery was seen in 11 patients. Mortality was seen in two patients with mucormycosis having disseminated infection.
Conclusion
Compared with previous literature, a relatively higher ratio of maxillary involvement was reported. Diabetes mellitus was the most common risk factor, followed by osteopetrosis and tooth extraction. Osteomyelitis secondary to mucormycosis in immunocompetent patients was relatively localized and gave favourable response to management compared with patients with diabetes mellitus.
The maxillary sinus (also known as the “maxillary antrum”) occupies a considerable part of the midface and is surrounded by important structures and organs. In addition to hypoplasia, This chapter provides information on the more frequent and/or important lesions arising within or immediately adjacent to the maxillary sinus. These are generally discovered when radiologically investigating a case of sinusitis which has not responded to the appropriate treatment. This is usually by antibiotics and decongestants. Lesions may also be discovered incidentally to radiology for another clinically indicated reason. The most serious of these are malignancies, which present with destruction of the bone. The most frequent malignancy of the sinus is squamous cell carcinoma, then non‐Hodgkin lymphoma, and rarely osteosarcoma. The more benign lesions present as dome‐shaped expansions of the sinus floor. Those essentially composed of soft tissue are separated on whether a cortex/ bony capsule just under the sinus mucosa is present or not.
Introduction
Zygomatic bone osteomyelitis is a rare condition having an incidence of 1.42%. Zygomatic osteomyelitis can be due to haematogenous infection with tubercle bacillus, facial bone fractures or very rarely due to an unknown aetiology like in our case. If surgically managed alone, it would lead to complete loss of zygomatic bone, causing high morbidity to the patient in terms of function and aesthetics like loss of globe support causing dystopia, loss of facial projection causing facial asymmetry. Restoration of facial symmetry and globe support would require extensive procedures such as non-vascular bone grafting or patient-specific implant placement or microvascular bone flap transfer.
Materials and Methods
Hyperbaric oxygen therapy (HBOT) was used to try and preserve the zygoma by promoting revascularisation. The patient received 100% oxygen at 2.5 absolute atmospheric pressure for 90 min, one session per day for 5 days in a week using a mask system in a multiplace chamber. The patient was reviewed clinically and radiologically after each 5 dives of HBOT sessions. After a total of 30 dives of HBOT, CT examination was repeated. There was partial reconstitution of cortical bone without any additional residual bone lesion. Minimal residual sequestra were noted. At this stage, the patient underwent conservative sequestrectomy in contrast to extensive surgery if HBOT was not contemplated.
Conclusion
HBOT has the potential to be a very useful adjunct in the treatment of osteomyelitis in head and neck surgery; however, there is a need for carefully designed trials, avoiding methodological bias due to the great variability of patients, infectious agents, antibiotic resistance, host factors, to broaden the evidence of this therapeutic modality.
Infections of the head and neck region most often arise from an odontogenic (dental) source, but they can also arise from non-odontogenic sources such as tonsils, paranasal sinuses, middle ear, salivary glands, developmental cysts, and skin. Severe dental caries, pericoronitis, periodontitis, dental surgery, tonsillitis, sinusitis, penetrating traumatic injuries, otitis media or otitis interna, sialadenitis, and facial acne can cause severe infections that can spread to the deep neck spaces and, sometimes lead to serious complications and occasionally result in death. The clinical manifestations of the infections and related complications vary based on the anatomic origin of the infection and path of spread of the infection. Frequently, individuals with systemic comorbidities, such as diabetes, other immunosuppressive disorders, and substance abuse, and those with limited access to healthcare due to socioeconomic reasons and, poor health literacy may delay seeking care and present with more severe infections. This group of patients are more likely to have life-threatening complications such as airway obstruction, cervical necrotizing fasciitis, descending necrotizing mediastinitis, Lemierre’s syndrome (internal jugular vein thrombosis), pericarditis, thoracic empyema, endocarditis, cavernous sinus thrombosis, orbital apex syndrome, brain abscess, osteomyelitis, sepsis and septic shock, and occasionally death. Fortunately, such complications are less common in the present day. Today, we can diagnose infections more accurately with advanced imaging techniques, manage the airway better with endoscopic airway evaluation and indirect visualization tools for intubation, and provide surgical and medical treatment early with appropriate intravenous antibiotics, fluids, and nutrition. Despite these improvements, life-threatening complications do occur; often, due to delay in presentation, delay in diagnosis, or delay in treatment. Also, inadequate treatment or failure of response to treatment can cause significant morbidity and mortality. In this chapter, the authors have compiled the information from their experience and the numerous published retrospective case series and case reports to provide the reader with the knowledge and tools to avoid and to manage serious life-threatening complications of infections. They discuss the literature on predisposing risk factors, etiology, and review the applied anatomy, clinical and radiographic features, diagnosis, management and prevention of some of the complications of odontogenic, and non-odontogenic infections.
Osteomyelitis of the jaws is now an uncommon disease usually caused by trauma or complications from surgical extractions. Although similar to osteomyelitis of the long bones, it is important to recognize that when it occurs in the jaws, it has very different management protocols and outcomes. This chapter presents two cases of both acute and chronic osteomyelitis of the jaws and explains their etiology, diagnosis, and medical and surgical treatment.
As discussed in a previous chapter, there are several different etiologies for mandibular osteomyelitis. Treatment is to a large extent cause specific since the differing pathophysiologies involved require different approaches. Odontogenic osteomyelitis can often be treated medically with a prolonged course of antibiotics. When surgical debridement is necessary, the treatment will still be medical once debridement has been completed unless a pathologic fracture has occurred. On the other hand, if a fracture is present, treatment should be similar to that described here for posttraumatic osteomyelitis (PTOM).
Maxillary osteomyelitis is a rare disease, especially in the pediatric population. We present a case of maxillary osteomyelitis in an eight-year-old girl with favorable outcome. Diagnosis was based on magnetic resonance imaging as well as on direct inspection intra operatively. Treatment should be based primarily on clinical signs (e.g. loose teeth). Teeth should not been extracted if healthy. © 2019 Journal of Clinical Pediatric Dentistry. All rights reserved.
Introduction
The caseload of jaw osteomyelitis seem to have decreased considerably over the last fifty years thanks to the progress of oral hygiene, the appearance and the use of antibiotics, and early screening. ‘Limited osteitis’ remains frequent in general practice (alveolitis after dental extraction), but osteomyelitis is much rarer as evidenced by the lack of current literature and the low number of reported patients in the published series. The aim of this study was to analyze retrospectively all the cases of maxillo-mandibular osteomyelitis treated in a large academic department of Stomatology and Maxillofacial Surgery over a period of 6 years and to compare the results to data from the literature.
Material and method
All patients diagnosed with maxillo-mandibular osteomyelitis by one of the staff surgeons between January 2009 and December 2015 was included. An epidemiological record (sex, age, ethnic background, risk factors, clinical, origin of disease, imaging and biology, treatments and progression) were collected for each patient. Osteomyelitis cases were classified according to the Zurich Classification System. Results were compared to data from the literature.
Results
Forty patients were retained. Three presented acute osteomyelitis, 26 secondary chronic osteomyelitis and 11 a primary chronic osteomyelitis. Osteomyelitis affected predominantly the mandible (87%). Dental origin was found in 90% of cases. Nine patients (22.5%) recovered and 29 (90%) were clinically improved. Ten of the 11 patients with primary chronic osteomyelitis were improved.
Discussion
This cohort study is one of the largest series currently available and presents results comparable to those of the literature of the last 25 years.
Osteomyelitis of the jaws has become a rare disease after the introduction of antibiotics in clinical medicine. This chapter discusses the oteomyelitis of the jaws from the perspective of the infectious disease specialist, the microbiologist, and the maxillofacial surgeon. It covers acute and secondary chronic osteomyelitis in detail. There are several underlying conditions that can be considered as risk factors for the occurrence of osteomyelitis of the jaws. The most important conditions are dental and periodontal infection, chronic sinusitis, dental implants, fracture with or without internal fixation, and facial infection. The chapter also discusses the clinical features, laboratory investigation, imaging procedures and management of osteomyelitis of the jaws. The goals of osteomyelitis therapy of the jaws are focus eradication by meticulous debridement including removal of dead bone and unstable internal fixation devices, combined with correct empirical and pathogen-directed antimicrobial therapy.
Osteomyelitis of the jaws is still a very unique disease of the facial skeleton that represents a great challenge for the physician as well as the patient being treated, despite all recent advances in diagnosis and evolved treatment modalities. In the past decades the clinical appearance of osteomyelitis cases has changed dramatically. Not only has the average number of cases seen in a maxillofacial unit decreased, but also the clinical picture of the disease itself has changed significantly. Osteomyelitis of the jaws used to be an infectious disease with an often complicated course, involving multiple surgical interventions and sometimes leading to facial disfigurement as a result of loss of affected bone and teeth and the accompanying scarring. The outcome was usually all but certain; hence, prolonged treatment and frequent relapses have been associated with this disease in the past.
OBJECTIVES: To provide average measurements relating the external mandibular cortex (EMC) to the inferior al-veolar canal (IAC) using CBCT. METHODS: 100 CBCT images from UWC Dental hospital patient database were analysed using CBCT software (NewtomVGi Image works Corps) to produce coronal slices at four defined points along the IAC. Each point was measured from the IAC to the outer aspect of the mandibular buccal cortex and to the alveolar ridge crest (edentulous mandibles) or buccal cortical plate crest (dentate mandibles). The paired t-test was used to analyse right and left side measurements in order to test for differences in right and left side means. RESULTS: A mean width of 5.891mm (±1.09) from the IAC to the EMC in the horizontal plane and a mean height of 13.068mm (±2.963) from IAC to the alveolar crest or buccal cortical plate was demonstrated. Mean height was lower in edentulous mandibles (11.142mm in females; 13.490mm in males) than in dentate mandibles (12.916mm in females; 14.102 in males). There was no significant difference in width values. Height values were greater in males (14.102mm) than in females (12.916mm), being marginally significant (p-value of 0.00948:p
In einer statischen Kultur, wie sie z. B. auf einer Agarplatte oder in einer Nährbouillon vorliegt, durchläuft der eingeimpfte Keim verschiedene Wachstumsphasen, nämlich die Anlauf-Phase (lag-Phase), die exponentielle Phase (log-Phase) und die stationäre Phase (Abb. 3.1) [6]. Das Wachstum wird limitiert, wenn ein Nährsubstrat verbraucht oder toxische Stoffwechselprodukte angehäuft worden sind. Auch pH-Wert-Erniedrigungen oder -Erhöhungen können hierbei eine wachstumsbegrenzende Wirkung haben.
There is no generally accepted definition for chronic osteomyelitis, a term that has been employed to describe bone infections based on temporal, histologic, or etiologic factors. Waldvogel et al. (76) considered, for epidemiologic purposes, only those patients with a prior admission for the same infection. This narrow definition identifies one group of patients with chronic osteomyelitis, but tends to exclude patients with the initial onset of indolent bone infection as well as many patients with osteomyelitis complicating foreign bodies, including orthopedic appliances. Other authors have used histologic criteria to separate acute from chronic osteomyelitis (5), and many of the experimental models have used this approach as well.
Osteomyelitis of the jaws is still a fairly common disease in maxillofacial clinics and offices, despite the introduction of antibiotics and the improvement of dental and medical care. The literature on this disease is extensive. Different terminologies and classification systems are used based on a variety of features such as clinical course, pathological-anatomical or radiological features, etiology, and pathogenesis. A mixture of these classification systems has occurred throughout the literature, leading to confusion and thereby hindering comparative studies. An overview of the most commonly used terms and classification systems in osteomyelitis of the jaws is given at the beginning of this chapter. The Zurich classification system, as advocated in this textbook, is primarily based on the clinical course and appearance of the disease as well as on imaging studies. Subclassification is based on etiology and pathogenesis of the disease. Mainly three different types of osteomyelitis are distinguished: acute and secondary chronic osteomyelitis and primary chronic osteomyelitis. Acute and secondary chronic osteomyelitis are basically the same disease separated by the arbitrary time limit of 1 month after onset of the disease. They usually represent a true bacterial infection of the jawbone. Suppuration, fistula formation, and sequestration are characteristic features of this disease entity. Depending on the intensity of the infection and the host bone response, the clinical presentation and course may vary significantly. Acute and secondary chronic osteomyelitis of the jaws is caused mostly by a bacterial focus (odontogenic disease, pulpal and periodontal infection, extraction wounds, foreign bodies, and infected fractures). Primary chronic osteomyelitis of the jaw is a rare, nonsuppurative, chronic inflammation of an unknown cause. Based on differences in age at presentation, clinical appearance and course, as well as radiology and histology, the disease may be subclassified into earlyand adult-onset primary chronic osteomyelitis. Cases with purely mandibular involvement are further distinguished from cases associated with extragnathic dermatoskeletal involvement such as in SAPHO syndrome or chronic recurrent multifocal osteomyelitis (CRMO).
Imaging is a crucial diagnostic tool in the assessment of acute and chronic osteomyelitis of the jaws. Before any cross-sectional imaging modality is applied, the orthopanoramic view is the first image to assess the status of dentition, recognize direct radiographic signs of osteomyelitis, narrow the differential diagnosis, and depict potential predisposing conditions such as a fracture or systemic bone disease. The orthopanoramic view is furthermore the first-line image when follow-up examinations are performed. In acute osteomyelitis the higher sensitivity of magnetic resonance imaging (MRI), with respect to detection of intramedullary inflammation, advocates its use as the imaging modality of choice to confirm the diagnosis and provide an estimate of the intraosseous extent and soft tissue involvement. In case surgical treatment is planned, high-resolution computed tomography (CT) is required to specify the degree of cortical destruction, delineate the presence of sequestra, and to define the extent of osseous removal required. In chronic osteomyelitis the higher sensitivity of CT with respect to detection of sequester and sclerotic bone changes renders CT the examination of choice to distinguish the usually more uniform and extensive primary chronic osteomyelitis from the more localized type of secondary chronic osteomyelitis. Magnetic resonance imaging is superior to detect periosteal inflammation and soft tissue involvement and thus aids in determining the persistence or recurrence of infection. Following surgery, CT is preferred as follow-up examination for a period of 6 months to distinguish postoperative and reparative changes from recurrent or persistent infection. Complimentary information is gained in particular situations by a combination of imaging modalities adapted to the individual patient’s course of disease and the panoramic view findings. An overview of the diagnostic imaging pathway in patients with suspected osteomyelitis of the jaws is given in Fig. 3.1.
Anemia is the most common disorder of the blood, with a broad spectrum of underlying causes. The most important conditions and entities resulting in or representing anemia are discussed in this chapter. Detailed information is provided for hemoglobinopathies (as sickle cell anemia and thalassemia), for primary anemias and bone marrow insufficiency (aplastic anemia, and serous atrophy). Information on age-related anemias includes inherited anemias in the child, as well as acquired anemias in the elderly. For each entity, the etiology and clinical background, followed by mechanisms and histology, and imaging characteristics are provided. The clinical symptoms of anemia are relatively uniform. However, imaging characteristics as extramedullary hematopoiesis, or complications as osteonecrosis or osteomyelitis are more likely in some forms of anemia. Disease- and treatment-related bone marrow patterns are also discussed.
Osteomyelitis of the jaws, although well documented, is rare, but osteomyelitis of the maxilla is extremely rare. We report the case of a 56-year-old Togolese man with avulsion of part of his maxilla.
Copyright © 2015. Published by Elsevier Ltd.
Osteonecrosis of the jaws associated with bisphosphonate and other anti-resorptive medications (ARONJ) has historically been a poorly understood disease process in terms of its pathophysiology, prevention and treatment since it was originally described in 2003. In association with its original discovery 11 years ago, non-evidence based speculation of these issues have been published in the international literature and are currently being challenged. A critical analysis of cancer patients with ARONJ, for example, reveals that their osteonecrosis is nearly identical to that of cancer patients who are naive to anti-resorptive medications. In addition, osteonecrosis of the jaws is not unique to patients exposed to anti-resorptive medications, but is also seen in patients with osteomyelitis and other pathologic processes of the jaws. This article represents a review of facts forgotten, questions answered, and lessons learned in general regarding osteonecrosis of the jaws.
The occurrence of maxillary osteomyelitis is rare in immunologically normal hosts. The nature of such infections is mainly polymicrobial, commonly attributable to micro-organisms present in the oral cavity. A case of acute maxillary osteomyelitis with Escherichia coli and Enterococcus spp. infection is described in an otherwise healthy young female. Cases of maxillary osteomyelitis reported in immunocompetent individuals lacking any predisposing factors are also reviewed. The lesion presented as a painful bone swelling and incomplete wound healing after tooth extraction, showing radiolucency with irregular borders. The isolated microbial species were E. coli and Enterococcus spp. Contamination from an extra-oral source through the wound may be implicated in the pathogenesis. A combination of surgical and antibiotic treatment proved to be successful. Nine maxillary osteomyelitis cases have been reported in the literature in immunocompetent individuals. Isolation of enteric bacteria was not described in any of those cases. Osteomyelitis should be included in the differential diagnosis of maxillary osteolytic lesions even in healthy individuals. The microbiological diagnosis is important for the antimicrobial intervention. This review shows that the main causative infectious agents in osteomyelitis remain unclear, as various bacteria have been reported to be involved.
A 68-year-old diabetic woman with chronic refractory osteomyelitis involving the mandible and maxilla following dental implant placement is presented. The inflammatory lesion showed actinomycotic findings histopathologically and refractory responses to several surgical and medical treatments for over 2 years. A periapical lesion on an adjacent tooth was overlooked as a possible source of infection. The lesion was cured after complete surgical debridement in combination with long-term antibiotic therapy.
Osteopetrosis is a rare genetic disorder that causes generalized sclerosis of the bone due to defect in bone resorption and remodeling. Albergs-Schonberg disease or autosomal dominant osteopetrosis type II is a rare form of osteopetrosis. Osteomyelitis is a well-documented complication of osteopetrosis. Any associated dental abnormality may be attributed to the pathological changes in bone remodeling. This case report discusses a case of osteopetrosis with osteomyelitis as a complication in a 8-year-old boy.
There is a paucity of recent data on osteomyelitis of the jaws particularly in the Saudi population. The purpose of the present study was to determine and update the informations associated with such disease in the Saudi population. Patients who attended King Abdul-Aziz University Hospital, faculty of dentistry oral surgery clinics and many centers in Jeddah, Kingdom of Saudi Arabia , from January 2000 to December 2010 underwent a retrospective chart review for osteomyelitis of the jaws . One thousand patients out of 3000 reviewed showed jaw bone involvement . Only 300 of 1000 patients showed actual inflammatory jaw bone conditions ; 42 of them met the criteria for osteomyelitis of the jaws. The most common risk factors associated with osteomyelitis of the jaws were tooth extraction, orofacial malignancy and radiotherapy, and bisphosphonates use. The most common symptoms were pain, exposed bone/plate and cheek swelling. Aerobic (GP 84%, GN 42%) and anaerobic (GP 53%, GN 27%) bacteria were identified. Antibiotics were given to 34 % of patients for more than 4 weeks intravenously. Five patients achieved full recovery. Limited recovery was associated with orofacial malignancy and radiotherapy (p= 0.06). The length of antibiotic therapy or hyperbaric oxygen therapy did not predict treatment outcome.
Postoperative bone healing after oral surgical procedures occurs uneventfully in most cases. However, in certain patients, the normal process of healing can be delayed and, in some cases, often because of multiple coexisting factors, the sites can become infected, with extension of the infection into medullary bone. This process is termed osteomyelitis. This article outlines the pathogenesis, microbiology, and surgical and medical therapies of this condition and specifically addresses osteomyelitis cases related to patients with no documented history of radiation or bisphosphonate exposure and in whom the principal factor in the development of the condition is infection by pyogenic microorganisms.
The aim of this study was to evaluate the diagnostic efficacy of bone scintigraphy (BS) and radiolabeled white blood cell scintigraphy (WBCS) in detecting septic activity in the flat bones of the jaw. A retrospective analysis was conducted using 38 studies of combined BS plus WBCS: 33 of them 3-phase BS and 36 of them 2-phase WBCS. These studies were performed on 34 patients, 19 women and 15 men with a mean age of 56 years (22-79), who presented with suspected mandibular osteomyelitis, either acute or chronic exacerbation. The results were compared with histologic findings (55%) or with a minimum clinical/radiologic follow-up of 6 months (average, 21 months), when biopsy results were not available. BS showed a sensitivity of 100%, a specificity of 6.7%, a positive predictive value of 62%, and a negative predictive value of 100%. For WBCS, the corresponding values were as follows: 73.7%, 78.6%, 82%, and 69%. Accuracy was 63.2% for BS and 94.7% for WBCS. WBCS has proven to be a useful test for detecting septic activity in the jaw bone, being more effective than BS alone, which under certain circumstances, can return a very high false-positive rate.
To determine the frequency of mandibular osteomyelitis (OM) in patients with congenital insensitivity to pain with anhidrosis (CIPA) and to relate its appearance to possible risk factors.
The records of 33 patients were reviewed for data concerning events of jaw OM, oral trauma, maxillofacial interventions, or OM of long bones.
Eighteen percent of the patients had mandibular OM. Of the six patients, preceding oral laceration was documented in one and tooth extraction in two. Seventy percent of the patients had OM of the limbs, but only 15% overlapped, having both jaw and limb OM. Half of the patients with mandibular OM had also OM of the limbs during the following year. There seems to be a correlation between high frequency of limb OM (at least 5 events per patient) and appearance of mandibular OM.
The incidence of mandibular OM is very high among patients with CIPA and can result in pathologic fracture and the need for open reduction and internal fixation. The reason for this phenomenon is presently not clear. Preventive and therapeutic strategy for CIPA patients should be undertaken to minimize this severe complication.
The high incidence of osteomyelitis of maxilla and mandible in children in Nigeria as seen at the Maxillo Facial Unit, Kaduna, is highlighted. Ulceromembranous gingivitis, rather than odontogenic infection, is stressed as the main factor in the initiation of osteomyelitis of maxilla and mandible in children in approximately 150 cases, seen over a period of four years. Malnutrition and debilitating diseases are shown to be major contributing factors in the process of the disease. Four cases are reported and discussed, illustrating various degrees of severity and subsequent common complications. The treatment of osteomyelitis of maxilla and mandible is discussed and a general outline of the treatment is presented.
The present communication deals with cases of acute osteomyelitis of the jaws—both upper and lower—which occur most commonly in the first few weeks or months of life, and very rarely beyond that period, and which are characterized by: (1) pathologic manifestations associated with the osteomyelitis, which are referable to the mouth, the nose, the nasopharynx and the orbit; (2) the clinical manifestations associated with an acute infection of severe intensity; (3) sequestration and loss of the entire jaw and of the teeth that it customarily carries; (4) the subsequent deformity associated with this loss in the cases in which recovery takes place, and (5) a high mortality.
Similar clinical entities have been described under various names: "gangrenous or sequestrating inflammations of the teeth-pulp of early infancy" (Bronner); maxillary osteomyelitis of infants (Bronner); gangrenous osteogingivitis (Comby, Cozzolino and Bindi); phlegmonous pulpitis (Bronner); sequestrating inflammation of the upper jaw (van Gilse¹
Competent treatment of fractures in adolescents includes specific knowledge about the incidence, age distribution and causes of these fractures. The current study reports about a multi-centre epidemiological investigation on 682 long bone fractures in children and adolescents involving 13 hospitals in Germany, Austria and Switzerland. The fractures were classified according to the “Li-La” classification, introduced von Laer and co-workers [19]. This classification uniquely takes into consideration the special conditions of fractures in the growth period. There were 1.3 times more fractures in boys than in girls. Most fractures occurred at the age of thirteen to fourteen. Almost 90 % of the fractures were mono-injuries. Somatic pre-disposition factors (cerebral palsy or cystic bone tumours, e. g.) were found in 3.8 %. Most fractures were observed in the upper extremity (73.7 %) and in the metaphysis (65.1 %). The most injured regions were the distal forearm (41.6 %), the distal humerus (14.6 %) and the tibial shaft (10.8 %). Fractures of the shaft decreased after the age of ten, whereas articular fractures significantly increased at the end of adolescence. The most frequent cause was sports activity followed by accidents at home or on playgrounds. There was significant relation between distal humerus fractures in infants and playground accidents, distal forearm fractures and sports injuries, and tibia-fibula and ankle fractures after traffic accidents in teenagers.
An unusual case of rapid bone regeneration after resection of a large portion of the mandible is presented. The possible factors responsible for the bone regeneration are discussed, with emphasis on the age of the patient, preservation of the periosteum, and infection.
Prophylactic metronidazole was found to be an effective means of preventing 'dry socket' after routine dental extractions. The oral anaerobic bacterial may be implicated therefore in the development of the disorder. It has been confirmed in this study that 'dry socket' occurs following three per cent of routine dental extractions and almost exclusively in the mandible. The causes of the condition are probably numerous and may even vary from patient to patient, but the control of infection by anerobic organisms may be important in its prevention or early resolution. The prophylactic administration of metronidazole (Flagyl) has been shown to be a simple and effective method of prevention which would suggest the implication of anaerobic organisms in 'dry socket'. The drug appears to be free from side effects when a dosage of 200 mgs eight hourly for three days is given.
The efficacy of metronidazole in the treatment of acute dental infections was investigated and compared with parenteral penicillin in a controlled trial. All 37 patients in the trial responded satisfactorily and metronidazole appeared to be as effective as parenteral penicillin. A further 24 patients treated with metronidazole also responded satisfactorily. Bacteriological studies of pus obtained from 25 patients revealed the presence of many species of obligate anaerobes. Since metronidazole is only active against obligate anaerobic bacteria it is concluded that these organisms are the important pathogens in acute dental infections.
An angiographic study of 23 cadavers and 100 patients showed that arterial disease affected the inferior dental artery earlier in life than the rest of the carotid arteries and their branches. Approximately a 15-year difference was noted, the difference being highly significant statistically. The loss of teeth was associated with these changes but statistically the correlation was less significant. The possible reasons for these changes and the surgical implications are discussed.
Although isolated case reports of mandibular osteomyelitis complicating chronic alcoholism appeared in the literature,1 the frequency of bone infection among patients suffering from chronic alcoholism was not generally recognized. It has become apparent from the following report that the incidence of mandibular osteomyelitis, although rare in the over-all population, increases frequently in patients with a diagnosis of chronic alcoholism. Because of this apparent unique susceptibility, oral surgeons involved in the care of these patients should bear in mind the increased potential for mandibular osteomyelitis, especially in those cases in which mandibular compound fractures are involved.
Adult Rhesus monkeys were used as experimental models to investigate revascularization and bone healing in different single-stage anterior, posterior and total maxillary osteotomy techniques.
Microangiographic and histologic studies demonstrated that intraosseous and intrapulpal circulation to the mobilized maxillary segments were maintained by the experimental flap designs which maintained intact soft tissue; the fragments healed by osseous union within six weeks without immobilization of the mandible.
The treatment of many severe dental-facial deformities is difficult and challenging. Functional and stable occlusions with facial balance and harmony have been attained in many adult patients by maxillary osteotomy techniques.
The Rhesus monkey serves as an excellent experimental model to develop new biologically sound maxillary surgical orthodontic techniques.
Thirteen cases of chronic osteomyelitis of the mandible have been reported. The clinical pictures presented have emphasized that previous dental caries and tooth extractions were the probable causative agents in eight cases. Usually the lesion was demonstrable in the body and angular area of the mandible. In six cases cultures from the discharge showedStaphylococcus aureus. Optimum treatment should include an accurate bacterial diagnosis and therapy with the appropriate antibiotics for not less than 6 weeks, followed, if necessary, by removal of necrotized bone and granulation tissue using the so-called “saucerization” technique. All eight patients treated with this technique were completely cured, with a postoperative observation time of not less than 4 months. In the group of five patients treated with antibiotics and incision alone, complete cure occurred in only one. The study has demonstrated the beneficial results obtained following careful choice of the correct time for surgical intervention as indicated by the roentgenologic finding of sequestra demarcated from intact bone.
A case of sickle cell osteomyelitis of the mandible is described. The etiologoy and management of the condition is discussed.
A review of 34 consecutive cases of chronic osteomyelitis of the mandible in adults seen at our clinic is presented. Periodontal disease was the main contributory factor while staphylococcus aureus was the commonest infecting organism. The lesions were readily diagnosed and were treated by sequestrectomy under antibiotic cover.
A review of 63 Nigerian children with salmonella osteomyelitis showed that in all but 2 of them the disease occurred in association with HbS either in the homozygous state (57 patients) or in heterozygous combination with other haemoglobins (4 patients). Osteomyelitis was most prevalent during the first 2 years of life, and boys were more often affected than girls. In the majority, multiple sites were involved and lesions were usually bilateral and often symmetrical. Salmonella sp. was isolated from blood or pus, or both, in all patients. In some patients additional pathogens were also isolated from blood or pus. Clinical presentation was variable. In many patients the illness was slight and they were treated entirely as outpatients, but serious toxaemia, severe bone lesions with pathological fractures, and chronic suppuration occurred in others. Most patients responded well to chloramphenicol and conservative management. There were 4 deaths. 17 patients recovered with sequelae. It is suggested that the peculiar susceptibility of patients with sickle cell anaemia to salmonella osteomyelitis is due to spread of salmonella from the intestine facilitated by devitalisation of gut caused by intravascular sickling, and that infarcts in bone became infected either by transient bacteraemia or by activation of dormant foci of salmonella in bone marrow when tissues are devitalised. It is further suggested that immunological defects in sicklers may impair host response to infection, while haemolysis and hepatic dysfunction, both of which occur in sickle cell anaemia, favour propagation of salmonellae.
1. The literature on acute osteomyelitis of the maxilla in infants is reviewed and the improvement in the prognosis since the introduction of chemotherapy is noted.
2. The clinical features, diagnosis, surgical anatomy, pathology, and bacteriology are discussed and the constant pathogenicity of the staphylococcus aureus stressed. It is suggested that the first deciduous molar tooth is the centre of the early bone infection, and that the infection begins in the mucosa overlying this tooth.
3. Two cases are reported. Both were caused by a penicillin-resistant staphylococcus aureus.
4. The early use of aureomycin in an attempt to abort the infection is advocated.
The ecologic, clinical, microbiologic, histologic, and therapeutic aspects of noma (gangrenous stomatitis) have been reviewed. A case report has been presented, with a discussion of clinical, roentgenographic, microbiologic, and therapeutic aspects, which emphasizes the significant contributions of the pooled knowledge of a hospital team in bringing about the successful resolution of a case of noma superimposed upon existing physical debilitation and malnutrition.
Total maxillary necrosis following severe road accident
- Cornah
Campbell's Operative Orthopaedics
- Calandruccio
Reaction of bone to trauma and infection
- Israel
Thoma's Oral Pathology
- Killey
Chronic osteomyelitis of the mandible: a clinical study of thirteen cases.
- Kinman J.E.G.
- Lee S.H.
Osteomyelitis of the mandible and maxilla in children.
- Adekeye E.O.
- James J.D.
- Sharma R.I.
Pyogenic osteomyelitis of the mandible in adults: a review of 124 cases and a report of 4 cases
- Adekeye
Pathological fractures of long bones in Nigerian children and adolescents
- Ebong