Acute Suppurative Osteomyelitis of the Mandible: A Clinical Overview

Acute Suppurative Osteomyelitis of The Mandible: A Clinical Overview

Question. Describe the etiology, histopathology, and clinical features of acute suppurative osteomyelitis in an adult patient’s mandible.
Or
Describe etiology, histopathology and clinical features, and complications of acute suppurative osteomyelitis in an adult patient’s mandible.

Answer. Acute suppurative osteomyelitis is a serious sequel of periapical infection, there is diffuse spread of infection throughout medullary spaces with subsequent necrosis of a variable amount of bone.

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Etiology

• Direct spread of infection from dental pulp into the mandible.
• Spread of infection in the mandible from presenting suppurative odontogenic infections.
• Spread of infection following removal of a tooth without proper asepsis and antibiotic coverage.
• Compound fracture of mandible with exposure of bone outside the mucosa.
• Post­radiation secondary infection.
• Infection to the preexisting bony lesions, e.g. Paget’s disease of bone and firous dysplasia.

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Clinical Features

• It occurs after the 50 years of age and males are more commonly affected.
• Mandibular lesions are diffuse in nature.
• Acute suppurative osteomyelitis of mandible in young adult causes severe pain, and diffuse and enlarged swelling of mandible.
• There is loosening and soreness of the regional teeth with difficulty in food intake.
• Multiple intraoral and extraoral pus-discharging sinuses often develops and moreover discharge of pus is seen from the gingival services of the affected teeth.
• Paresthesia of the lip is common.
• Patient is slightly febrile and general symptoms include fever, malaise, anorexia and vomiting.

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Histopathology

• In acute suppurative osteomyelitis, bone marrow undergoes liquefaction and purulent exudates occupy the marrow space.
• A large number of acute inflammatory cells infiltrations are present which shows PMNs with occasional presence of lymphocytes and plasma cells.
• Some areas of affected bone undergo necrosis with the generation of osteoblast and osteocytes cells and therefore resul1ts in the development of sequestrum (a piece of dead bone).
• When the acute phase of infection subsides in new shell of bone called “involucrum” is formed over the inflammatory focus.

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Complications

• Periostitis
• Cellulitis
• Abscess.