Infective bone disease
Dr. Mohamed Rahil Maxillofacial surgeon
Tikrit dentistry college
definition
• Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs.
Predisposing factors • Decrease blood supply • Decrease in host defence mechanism
osteomylitis
• More in mandible Decreased dramatically due to ; • AB • Improve nutrition • Better medical and dental care • Improvement of diagnostic modality
pathogenesis In maxillofacial region main causes of osteomlyitis; • Spreading of odontogenic infection • Trauma • Hematogenous spread (very rare)
Mechanism : o bacteria introduce to the bone o Induce inflamatory respons o Edema and hyperemia occure o Increase in the intrameduulary pressure lead to compromise
blood supply to the bone which aggrivate the condition o End point occurs when the pus exits the soft tissues and
form sinusis
Microbiology
• Staphylococcal species consider the most pathogen in osteomylitis of the jaw
• Other organisms as streptococcus , anaerobic MO as bacteroid ,peptostreptococcus
classification
• 1. Acute osteomylitis a. Contiguous focus b. Progressive c. Hematogenous 2. chronic osteomylitis a. Recurrent multifocal b. Garre’s osteomylitis c. Suppurative or nonsuppurative d. sclerosing
Clinical presentation
Pain (deep ) Swelling Lymphadenopathey Fever malaise Paresthesia of inferior alveolar nerve Trismus fistulas
Radiograph
• Acut osteomylitis usually show normal OPG • Chronic osteomylitis classicaaly show moth eaten
appearance , and bone sequestration
• Ct scan is the standard imaging in evalaution of osteomylitis
• MRI usfel in early detection of osteomylitis • PET scan can be used in detection of osteomylitis
Treatment
• Correct diagnosis is so important • History , clinical examination ,radiographical
evaluation • Biopsy ,culture and sensetivity • Medical evaluation and treating any
immunocompromised cases
Surgical treatment
• Sequestrectomy • Saucerization • Decortication • Hyperbaric oxygen
Osteoradionecrosis
• Bone necrosis as complication of radiotherapy • Occur due to trauma to the jaw (dental
extraction) or may occur spontanousely • Radiation dose above 5000 – 6000 rads • Clinically manifestated as pain and exposed
bone • Radiographically appear as osteomylitis
Treatment
• Debridment of exposed bone with hyperbaric oxygen
• HBO protocol ; 2,4 atm 90 min for each session
• 20 – 30 dives preoperatively before any surgical intervention followed by 10 additional div.
• If no response then resection of necrotic tissue and replased by free flap
osteochemonecrosis
• Biphosphanate therapy (zoledronate ,pamidronate )act as osteoclast inhibitor
• Used in treatment of ; osteoporosis,paget’s disease,multiple myeloma ,metastaic cancer
• Biphosphanate bone necrosis seen today as side effect to use these drugs
• Mechanism of bone necrosis differ from that occur due to radiotherapy
• In biphosphanate necrosis bone failed to regenerate after trauma as tooth extraction
Role of dentist in BRONJ treatment
• Medical consultation about the drugs that used by the patient
• Routine dental care • All dental procedures should be performed as
atraumatically as possible with little tissue trauma, bleeding ,and risk of postoperative infection
• If BRONJ occur, only sharp edges of exposed bone should be removed ,there is no definitive treatment till now
• In case of any infection aggressive use of systemic antibiotic is indicated
Actinomycosis
• Is a long-term (chronic) bacterial infection that commonly affects the face and neck.
• caused by bacterium called Actinomyces israelii
• Charactraised by Multiple sinuses discharge • Other symptoms ; Fever , Minimal or no pain ,
Swelling or a hard, red to reddish-purple lump on the face or upper neck ,Weight loss
Treatment
• Drainage of abscess • Removal of causative factors • Long term use of antibiotic ,mainly pencillin
mucormycosis • Mucormycosis refers to several different diseases caused by
infection with fungi
• occur mainly in immunocompromised patient .
• Most mucormycosis infections are life-threatening
• Severe infection of the facial sinuses, which may extend into the brain, is the most common presentation.
• Treatment requires correction of the underlying risk factor(s), antifungal therapy with amphotericin B, and aggressive surgery .
Thank you