CRANIOFACIAL OSTEOMYELITIS

Definition
• Inflammatory condition of the bone that
commences as an infection of the medullary
cavity, rapidly involving the haversian systems
and eventually involving periosteum of
affected areas.
• Invasion of bacteria into the cancellous bone
results in compression of the blood vessels
secondary to inflammation and oedema of the
marrow space. This results in ischaemia and
necrosis of the bone.
• Immobility of blood further serves as a critical
nidus for development of infection.
 Aetiology

• Skull based osteomyelitis originates from a

chronic infection which has been inadequately
treated.
• May result from trauma, bone surgery,
bacteremia or a contiguous infectious focus.
• Development of osteomyelitis is further
influenced by diseases that affect vascularity
of bone (radiation, malignancy, osteoporosis,
osteopetrosis, paget’s disease) as well as
systemic diseases that produce an alteration
of host defences (DM, anaemia, malnutrition).
• Bones that may involved include mandible,
frontal bone, maxilla, nasal bone, temporal
bone and skull base.
• In tooth bearing bone, osteomyelitis is usually
caused by polymicrobial odontogenic bacteria
which include Bacteroides,
Peptosterptococcus, microaerophilic
streptococcus ssp.
• Others organisms include Arachnia, Klebsiella,
Mycobacterium tuberculosis, Eikenella.
• Fungal: Candida parapsilosis and Aspergillus
ssp.
 Clinical presentation
• May present as a routine infection with fever,
malaise, pain and facial cellulitis.
• There may be no associated radiographic
changes ( it takes 10-12 days for bone loss to
be radiographically visible).
 diagnosis
• History and physical exam.
• Functional imaging of craniofacial skeleton
which may include CT scan or MRI.
• CBC will reveal elevated WBC’s.
• Blood culture or culture from pus in
originating focus of infection will reveal
causative organism.
 Treatment
• Patient is admitted for IV antibiotic treatment.
Clindamycin is the drug of choice because of its
effectiveness against streptococci and anaerobes.
• Role of surgical treatment: debridement of
involved soft tissue and bone.
• Where infection is secondary to a mandibular or
maxillary fracture, any non viable teeth must be
removed, as well as any loose bony fragments.
• Any foreign bodies ( ie wires, plating) that may
have been used for stabilization must also be
removed. The jaw must subsequently be
stabilized with tight intermaxillary fixation or
other choice of fixation technique.