Osteomyelitis

Osteomyelitis is defined as the inflammation of bone and its marrow contents.

It begins as an infection of medullary cavity and the Haversian system and extends to involve the
periosteum of the affected area.

Acute Suppurative Osteomyelitis

Acute suppurative osteomyelitis of the jaw is a serious sequela of periapical infection that often results
in a diffuse spread of infection throughout the medullary spaces, with subsequent necrosis of a variable
amount of bone.

Clinical features of this form of osteomyelitis, which arises from a dental infection, are the same as
those present after infection due to a fracture of the jaw, a gunshot wound, or even hematogenous
spread.

Dental infection is the most frequent cause of acute osteomyelitis of the jaws.

Causative Microorganisms
Staphylococcus aureus and Staphylococcus albus.
Anaerobes such as Bacteroides, Porphyromonas or Prevotella species.

Clinical Features
Site: Acute or subacute suppurative osteomyelitis may involve either the maxilla or the mandible.
In the maxilla the disease usually remains fairly well localized to the area of initial infection.
In the mandible, bone involvement tends to be more diffuse and widespread.
Age: The disease may occur at any age. Another form of acute osteomyelitis, referred to as neonatal
maxillitis in infants and young children.
The adult afflicted with acute suppurative osteomyelitis usually has severe pain, trismus, and
paresthesia of the lips in case of mandibular involvement and manifests an elevation of temperature
with regional lymphadenopathy.
The white blood cell count is frequently elevated.
The teeth in the area of involvement are loose and sore so that eating is difficult, if not impossible.
Pus may exude from the gingival margin.
Until periostitis develops, there is no swelling or reddening of the skin or mucosa.

Radiographic Features
Acute osteomyelitis progresses rapidly and demonstrates little radiographic evidence of its presence
until the disease has developed for at least one to two weeks.
At this time diffuse lytic changes in the bone begin to appear.
Individual trabeculae become fuzzy and indistinct, and radiolucent areas begin to appear.

Treatment and Prognosis

Drainage of pus along with antibiotic therapy.
Sequestrectomy or saucerization is done.
Histologic Features
The medullary spaces are filled with inflammatory exudates.
The inflammatory cells are chiefly polymorphonuclear leukocytes, but may show occasional lymphocytes
and plasma cells.
The osteoblasts bordering the bony trabeculae are generally destroyed, and depending upon the
duration of the process, the trabeculae may lose their viability and begin to undergo slow resorption.

Pathology.
The infection causes acute inflammation of the marrow tissue and the resultant inflammatory exudate
spreads through the marrow spaces. This causes compression of blood vessels in the bone, leads to
thrombosis and obstruction of blood flow, resulting in necrosis of the bone. Liquefaction of the necrotic
tissue, dead and dying inflammatory cells, and bacteria form the pus, and this may fill the marrow
spaces. This suppurative reaction extends through the cortical bone to involve the periosteum causing
lifting of the periosteum, which further leads to compromise in the blood supply to the underlying bone
resulting in further necrosis. By osteoclastic activity, the necrosed bone, known as sequestrum, is
separated from the surrounding vital bone and exfoliates through the sinus.