Infective bone disease

Dr.Mohamed Rahil (( Maxillofacial surgeon ))

Tikrit dentistry college 2015 – 2016

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 mandibleDecreased dramatically due to ;• AB • Improve nutrition• Better medical and dental care• Improvement of diagnostic modality

pathogenesisIn 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 responso 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 osteomylitisa. Contiguous focusb. Progressivec. Hematogenous 2. chronic osteomylitisd. Recurrent multifocale. Garre’s osteomylitisf. Suppurative or nonsuppurativeg. sclerosing

Clinical presentation

Pain (deep )SwellingLymphadenopatheyFevermalaiseParesthesia of inferior alveolar nerveTrismusfistulas

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 .

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