Osteomyelitis

The word “osteomyelitis” originates from the ancient Greek words osteon (bone) and
muelinos (marrow) and means infection of medullary portion of the bone.
It can therefore be considered as an inflammatory condition of the bone,
beginning in the medullar cavity and haversian systems and extending to involve the
periosteum of the affected area. The infection becomes established in calcified portion of
the bone when pus and edema in the medullary cavity and beneath the periosteum
compromises or obstructs the local blood supply. Following ischemia, the infected bone
becomes necrotic and leads to sequester formation, which is considered a classical sign
of osteomyelitis.
 Osteomyelitis

Sclerosing form Suppurative form

Chronic focal sclerosing form
Acute
Chronic diffuse sclerosing form
Chronic
Chronic osteomyelitis with proliferative periostitis (Garre's
chronic
 Dual classification based on Pathological, Anatomy and Pathophysiology

I. Acute suppurative form (rarefactional osteomyelitis).

II. Chronic suppurative form (sclerosing osteomyelitis).
III.Chronic focal sclerosing form (pseudo- paget, condensing
osteomyelitis).
IV. Chronic diffuse sclerosing form
V. Chronic osteomyelitis with proliferative periostitis (Garre's
chronic nonsuppurative sclerosing osteitis, ossifying
periostitis).
VI. Specific osteomyelitis
•Tuberculous osteomyelitis
•Syphilitic osteomyelitis
•Actinomycotic osteomyelitis
 Suppurative Osteomyelitis

Osteomyelitis is a very serious microbial infection of bone marrow that can cause
destruction of large sections of the jaw and be difficult to cure.
Etiology: Osteomyelitis is caused by virulent organisms and/or decreased
immunologic responses. Bacterial infection as result of untreated pulpal and/or
periapical infection. Also, infected wound and septic focous through blood stream.
An impaired immunologic defence is responsible. Patients who have impaired
immunologic defences are said to be "immunocompromised.“ There are a number
of situations that produce immunocompromised patients. Some diseases (e.g., HIV
infection) and some treatments (e.g., cancer chemotherapy) may produce
immunocompromised patients.
Clinically:
Osteomyelitis of the jaws, more commonly affects the mandible
rather than the maxilla, probably the maxilla's excellent blood
supply is the difference. There may be painful swelling of the
mandible and suppurative drainage into the oral cavity. There is
usually constitutional manifestations such as: malaise (discomfort),
pain, fever, and leukocytosis.
Radiographic features:

because osteomyelitis takes longer to develop than other acute

inflammatory lesions, usually there are significant and specific
radiographic changes. ill-defined radiolucencies. Indistinct outline
(diffuse growth pattern) and combination of radiolucencies and
radiopacities (mottled radiographic appearance) due the
simultaneously bone resoption and bone deposition.
Microscopically, osteomyelitis shows: In addition to
acute inflammation, in fibrous connective tissue,
inflammation and repair commonly occur
simultaneously. So it is in bone: inflammation-induced
bone destruction (resorption by osteoclasts) and bone
repair (deposition by osteoblasts). Treatment: includes
removal of cause, debridement, and vigorous antibiotic
therapy
Radiographic features: The lesion is marked by a periapical
radiopacity of a nonvital tooth. The radiopacity is usually well-
circumscribed; it may be demarcated from the surrounding bone by
a narrow radiolucent border.
Histological Features:.

Treatment: extraction, or endodontic therapy. Since the lesion may

resolve without further therapy, surgical intervention may not be
necessary unless it persists.
 Chronic diffuse sclerosing osteomyelitis

It is a chronic, osteomyelitis, infection of bone; usually without

severe signs or symptoms recognized by a diffuse radiopacity.
Clinical features: It is characterised bv; A recurrent episodes of intense pain
in the mandible. Often accompanied by trismus, paresthesia and progressive
mandibular deformity.
Radiographic features: The lesion is marked by a diffuse
radiopacity; it may be demarcated from the surrounding bone by a
narrow radiolucent border.
Histological Features: reveal the presence of new bone intermixed
with a fibrous connective tissue stroma in which chronic
inflammatory cells reside.
 Garre's Osteomyelitis (proliferative periostitis)

It is a type of chronic osteomyelitis that is nonsuppurative and primarily affects

children and adolescents. It commonly occurs in young patients with a mean age of 13
years, although sporadic cases have been reported in 20-65 year olds. Pathogenesis:
The process arises secondary to a low-grade chronic infection, usually from the apex
of a carious mandibular first molar. The infection spreads toward the surface of
the bone, resulting in inflammation of the periosteum and deposition of new bone
under the periosteum. This peripheral formation of reactive bone results in localized
periosteal thickening. The inferior border of the mandible below the carious first
molar is the most common site for hard nontender expansion of cortical bone.
Clinical features: The mandible is the most commonly affected
area in the maxillofacial region

Clinical features: The mandible is the most

commonly affected area in the maxillofacial
region
Clinical photograph showing mild obliteration of the
lower buccal vestibule
Radiographic feature reveals deposition of bone in the outer cortex of the inferior
aspect of the mandible on the right side
The radiographic appearance varies with the duration of the lesion and the degree of calcification.
During the early period, a thin crust-like convex layer appears over the cortex. As the event continues,
the cortex is thickened as a result of successive new bone deposits. This lamellar structure is referred to
as “onion skin” on radiographs
Intraoperative picture showing submandibular incision to expose the lesion (a)
and recontoured bone (b)