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

Jaw Osteomyelitis Treatment

• Conservative treatment.
• Surgical treatment.
  • The goal of management is
    • Attenuate 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 are 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 offending teeth.
• Debridement: Followed by incision and drainage, thorough debridement of the affected 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 an extraoral submandibular skin incision.
• Intraoral drainage can be established for the body of the mandible.
• Sequestrum formed should be removed, if it can be gently picked up (sequestrectomy).

Maxillary Osteomyelitis Treatment

• Removal of sequestrum.
• It may be carried out under the proper cover of antibiotics.
• Small sequstrae are removed under local anesthesia.
• General anesthesia may be given for the removal of a larger sequestrum.
• Sequestra from the lower border of the mandible are best removed by extraoral approach using Risdon’s incision.
• From the ramus, it may be removed by retromandibular incision.
• From the condyle by preauricular incision.
• The coronoid process is best approached by an oral incision given along the anterior border of the ramus of the mandible.
• After removal of the sequestrum, the residual granulation tissue is curetted till white shining bone appears.
• Bleeding is controlled by a 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 a 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 smoothed by a file.
• The wound can be partially or completely closed depending on the amount of suppuration.