Management Of Osteomyelitis Of The Jaws

Management Of Osteomyelitis Of The Jaws

• • Acute Osteomyelitis
  • Acute suppurative osteomyelitis
  • Acute subperiosteal osteomyelitis
  • Acute periostitis.
• Chronic Osteomyelitis
  • Nonspecific type:
    • Chronic intramedullary osteomyelitis
    • Chronic focal sclerosing osteomyelitis
    • Chronic diffuse sclerosing osteomyelitis
    • Chronic osteomyelitis with proliferative periostitis
    • Chronic subperiosteal osteomyelitis
    • Chronic periostitis.
  • Specific type:
    • Tuberculous osteomyelitis
    • Syphilitic osteomyelitis
    • Actinomycotic osteomyelitis.
• Radiation­induced osteomyelitis.
• Idiopathic osteomyelitis.

• Pain and tenderness is minimal.
• Non-healing bony and overlying soft tissue wounds with indurations of soft tissues.
• Thickened or wooden character of bone.
• History of chronic discharge in oral cavity or on face through the sinus present.
• Pathological fracture may occur.
• Teeth in area tend to become loose and sensitive to palpation and percussion.
• Lymphadenopathy is present.

• Conservative treatment.
• Surgical treatment.
  • The goal of management is
    • Attnuate and eradicate proliferating pathology-
    • cal organism.
    • Promote healing.
    • Re-establish vascular permeability.

• Early diagnosis.
• Bacterial culture and sensitivity test.
• Adequate and prompt antibiotic therapy.
• Adequate pain control.
• Proper surgical intervention.
• Reconstruction (if indicated).

• Complete bed rest.
• Supportive therapy: It includes nutritional support in form of a high protein and high caloric diet and adequate multivitamins.
• Dehydration control: Hydration orally or through IV fluid.
• Blood transfusion: When RBC and Hb is low.
• Control of pain: Analgesic and sedation.
• Intravenous antimicrobial agents: Penicillin.

• Done as soon as possible.
• It relieves pain and pressure caused by pus accumulation.
• Extraction of loose or offnding teeth.
• Debridement: Followed by incision and drainage thorough debridment of affcted area should be carried out.
• The area may be irrigated with hydrogen peroxide and saline thrice a day.
• Any foreign body, necrotic tissue or small sequestrum should be removed.
• Drainage for the body and angle of the mandible area is established through extra oral sub mandibular skin incision.
• Intraoral drainage can be established for the body of mandible.
• Sequestrum formed should be removed, if it can be gently picked up (sequestrectomy).

• Removal of sequestrum.
• It may be carried out under proper cover of antibiotics.
• Small sequestra are removed under local anesthesia.
• General anesthesia may be given for the removal of bigger sequestrum.
• Sequestra from lower border of mandible are best removed by extraoral approach using Risdon’s incision.
• Fromramus, itmaybe removed by retromandibular incision.
• From condyle by preauricular incision.
• Coronoid process is best approached by or intra oral incision given along the anterior border of ramus of the mandible.
• After removal of the sequestrum the residual granulation tissue is curettd till white shining bone appears.
• Bleeding is controlled by pressure pack.
• When complete infection has been eradicated the wound can be closed by primary closure.
• When the elimination of the infection is doubtful, a glove drain or a rubber drain is kept in place and is changed every 24 hours till no discharge from the bone, is seen.

• Removal of bony cavity.
• It consists of elimination for bony cavity in the jaw bone to avoid collection of blood and formation of large hematoma which is liable to get infected.
• It is simple procedure for eliminating the dead space inbone.
• Saucerization is carried out by existing the wall of the bony cavity by means of Rongeur bone-cuttng forceps or burs.
• The bone is smoothen by flie.
• The wound can be partially or completely closed depending upon the amount of suppuration.