Jaw Osteomyelitis is a purulent, infectious and inflammatory process that captures all the structural components of the jawbone and leads to osteonecrosis. Osteomyelitis of the jaw is accompanied by general symptoms( weakness, fever, chills) and local signs( pain, restriction of mouth opening, teeth mobility, inflammatory infiltration of the facial soft tissues, fistula, sequesters, abscesses, etc.).Osteomyelitis of the jaw is diagnosed on the basis of clinical and radiological signs, hemogram studies. Treatment of the osteomyelitis of the jaw includes antimicrobial and detoxification therapy, removal of the infected tooth, drainage of the subperiosteal abscess, sequestrectomy.
Jaw osteomyelitis is a purulent-inflammatory disease of the maxillofacial area, characterized by infection and destructive changes in the jaw bone. Osteomyelitis of the jaws occupies one of the leading places in the structure of surgical dentistry among the odontogenic inflammatory lesions, along with acute and chronic periodontitis, periostitis of the jaw. Among osteomyelitis of different localization, the share of osteomyelitis of the jaws accounts for about 30% of cases. Odontogenic osteomyelitis of the jaw is more often diagnosed at the age of 20-40 years, mainly in men. Osteomyelitis of the lower jaw develops 2 times more often than the upper jaw.
Classification of the jaw osteomyelitis
Given the source and mechanism of infection, the osteomyelitis of the jaws is divided into odontogenic( associated with the pathology of the teeth), hematogenic( associated with the introduction of infections from distant foci with blood flow) and traumatic( associated with direct damage to the jaws).
By the nature of the clinical course, maxillary inflammation can be acute, subacute or chronic. In accordance with the predominance of the processes of building or killing bone substance, 3 clinical and roentgenologic forms of chronic odontogenic osteomyelitis of the jaws are singled out: productive( without sequestration), destructive( with the formation of sequesters) and destructively productive.
Depending on the prevalence of purulent-necrotic process, the osteomyelitis of the jaw is limited( localized within the alveolar process or the jaw body in the area of 2-4 teeth) and diffuse( diffuse lesion of a significant part or all of the jaw).
Causes of osteomyelitis of the jaw
Odontogenic( dental) osteomyelitis of the jaw is the most common type of pathology, occurring in 75-80% of cases. As a rule, the development of odontogenic osteomyelitis of the jaw is etiologically associated with neglected caries, pulpitis, periodontitis, pericoronitis, alveolitis, dental granuloma or a tooth cyst. At the same time penetration of infection into the jawbone occurs through the infected pulp and root of the tooth.
The primary source of infection in hematogenous osteomyelitis of the jaw can be furuncles and carbuncles of the maxillofacial area, purulent otitis, tonsillitis, omphalitis and umbilical neoplasm of neonates, infectious foci with diphtheria, scarlet fever, etc. In case of hematogenous infection, jaw bone is first affected, and dental tissuesare involved in the purulent-inflammatory process again.
Traumatic osteomyelitis may be a consequence of fracture of the jaw, gunshot wound, damage to the mucous membrane of the nasal cavity. In these cases, the infection enters the bone tissue from the external environment. The share of traumatic osteomyelitis of the jaw accounts for 11% of cases, for hematogenous - 9%.
The pathogenic microflora that causes osteomyelitis of the jaws can be detected as monocultures or microbial associations and is mainly represented by Staphylococcus aureus, group B streptococcus, E. coli, Klebsiella, proteus, fusobacteria, Pseudomonas aeruginosa and other pathogens.
A definite value for the development of the osteomyelitis of the jaw has a state of general and local immunity. Osteomyelitis of the jaw is often accompanied by blood diseases, diabetes, polyarthritis, rheumatism, liver and kidney disease.
Symptoms of the jaw bone osteomyelitis
Acute osteomyelitis of the jaw bone manifests suddenly, with general symptoms. There is a sharp rise in body temperature to febrile values, chills, general weakness, weakness, lack of appetite, sleep disturbance.
In the case of odontogenic osteomyelitis of the patient's jaw, the pain in the area of the causative tooth that is the source of infection is of concern. Pain from the local soon becomes diffuse, radiating into the ear, eye socket, temple. Infected tooth, as well as adjacent intact teeth become mobile;the mucous membrane of the gum is swollen. From the gingival pockets often purulent contents are separated;From the mouth of the patient comes a fetid putrid odor. With the spread of infiltration on soft tissues, there is a restriction of opening the mouth, pain when swallowing, difficulty breathing. Osteomyelitis of the lower jaw proceeds with a violation of the sensitivity of the lower lip( numbness, tingling sensation, crawling crawling), mucous membranes of the mouth and skin of the chin.
In acute osteomyelitis of the jaw, marked inflammatory infiltration, edema and hyperemia of soft tissues, regional lymphadenitis, due to which the contour of the face becomes asymmetric.
For acute osteomyelitis of the jaws, the formation of subperiosteal abscesses, maxillary phlegmon, adenophlegmon is typical. Diffuse osteomyelitis of the upper jaw can be complicated by odontogenic sinusitis, phlegm of the orbit, thrombophlebitis of the branches of the facial vein.
In subacute jaw osteomyelitis, the general condition improves, inflammatory infiltration and suppuration decrease, but the pathological mobility of teeth remains and even increases.
Chronic osteomyelitis of the jaw is characterized by a protracted course and can develop as a result of acute osteomyelitis or as a primary chronic process.
The destructive form proceeds with symptoms of intoxication and lymphadenitis, against which fistulas with purulent exudate and swelling granulations are formed, as well as large sequesters. Chronic destructive osteomyelitis often leads to a pathological fracture of the jaw. With the destructive-productive form of chronic osteomyelitis, multiple small sequestrants are formed. In the productive form due to the prevalence of the processes of active construction of bone substance in the perience period, fistula and sequestra are absent;there is deformation of the jaw, ankylosis of the TMJ, trismus, infiltrates of soft tissues.
Diagnosis of the jaw bone osteomyelitis
In the acute phase, due to the absence or non-manifestation of the radiographic signs of the osteomyelitis of the jaws, the disease is diagnosed by a dental surgeon or traumatologist on the basis of clinical and laboratory data.
The hemogram deviations in osteomyelitis of the jaw are represented by neutrophilic leukocytosis, lympho- and eosinopenia, increased ESR.In the biochemical analysis of blood in large quantities, a C-reactive protein is detected, hyperglobulinemia and hypoalbuminemia are noted;in the general analysis of urine revealed erythrocytes, cylinders, traces of protein. To identify the pathogen shows the bacteriological culture of the inflammation released from the focus.
In the subacute and chronic phases, the dynamics of bone changes increases, which is revealed during the radiography or tomography of the jaws: osteoporosis and osteosclerosis, coarse-fibrous bone pattern, foci of sequestration are detected. When probing fistulas, uneven contours of bone sequesters are found.
Acute osteomyelitis of the jaw requires a differential diagnosis with purulent periostitis, acute periodontitis, suppurating jaw cysts, specific jaw lesions( tuberculosis, actinomycosis, syphilis), jaw tumors.
Treatment of the osteomyelitis of the jaw
The approach to the treatment of osteomyelitis consists of a complex of local and general activities. The primary task in osteomyelitis of the jaw is the elimination of the primary purulent focus: with odontogenic form - tooth extraction, with hematogenous - infection sanation, with traumatic - PCO of infected and PCO gunshot wounds.
Periostotomy, evacuation of pus, rinsing of the bone cavity with antiseptic solutions, draining with a rubber graduate or PVC pipe is carried out. Movable intact teeth are subject to medical splinting.
General measures include detoxification, symptomatic, immunomodulating, desensitizing therapy. It is prescribed massive antibacterial therapy with cephalosporins, semisynthetic penicillins, macrolides. Actively applied hyperbaric oxygenation, plasmapheresis, hemosorption, lymphosorption, autohemotherapy, UFO blood, local physiotherapy( UHF therapy, ultrasound therapy, magnetotherapy).
For chronic osteomyelitis of the jaw, sequestrectomy can be performed on the basis of the radiographic pattern - removal of sequestered bone sites. After removal of sequestration and granulation, the bone cavity is washed and filled with osteoplastic directed materials with antibiotics. When a pathological fracture threatens, the jaws are sealed.
Prognosis and prevention of jaw osteomyelitis
Timely diagnosis and correct management of acute osteomyelitis of the jaw in most cases ensures recovery. In the case of an unfavorable course of the osteomyelitis of the jaw, the ascending spread of the purulent process can lead to the development of meningitis, meningoencephalitis, brain abscess;Downward infection - to lung abscesses, mediastinitis and sepsis. Such complications often lead to death.
Outcomes of chronic osteomyelitis are often pathological fractures, ankylosis of the TMJ, false joints, scar tissue contractions of the masticatory muscles. The productive forms of chronic osteomyelitis of the jaw can be complicated by amyloidosis of the kidneys and heart.
Prophylaxis of the osteomyelitis of the jaw presupposes timely therapeutic treatment of caries, pulpitis, periodontitis;sanation of purulent foci in the body, strengthening immunity, preventing injuries to the maxillofacial area.
Jaw osteomyelitis is an inflammation of the jaw bone caused by infection. A dangerous disease, fortunately occurring quite rarely.
The causative agent of this disease are pathogenic bacteria: Staphylococcus aureus, Escherichia coli, Gram-negative bacteria, Klebsiella, Pseudomonas aeruginosa. Complexity - in its severe course and serious complications. During the remission inflammation captures not only the jaw tissue itself, but the entire bone system.
Reasons for osteomyelitis of jaw
Practically there are not so many reasons and ways due to which the virus or bacterium gets on the "fertile soil" with the subsequent development of the osteomyelitis of the jaw.
- Chronic diseases of a viral and infectious nature.
- The root cause is a complex form of periodontitis with subsequent complication.
- Acute pathogenic infection, which causes an inflammatory process.
- Through plasma( transfusion, injection. ..).
- Traumatism: injuries, fractures.
- The temporomandibular joint is much less likely to become a disease, namely its dysfunction.
Classification of jaw osteomyelitis
Disease that occurs as a result of jaw injuries or fractures. The traumatized site opens the virus to the bone, but the percentage of complications of this type is small.
A variant of the disease of the osteomyelitis of the jaw refers to complications resulting from a fracture of the facial bones. Most often this happens with the lower jaw, but there are also single cases of damage to the upper jaw. Trauma to the bone opens the passageway for infection, which, under favorable conditions for it, begins to develop even further away from the zone of the fracture.
Therefore, if it has already happened that the jaw is injured, everything must be done to prevent the pathogenic flora from getting into the wound.
Jaw osteomyelitis after tooth extraction
Everything in our body is interconnected. Closed by a single innervation and the upper from the lower jaw, being the processes of the triadic nerve( responsible for the sensitivity of the nerve endings of the face).When the dentist is forced to wring out a sick tooth, it also removes the dental nerve, while the nerve endings of the gum and periodontal remain and are irritated due to pain after tooth loss( pain can be felt for up to a week).
If the pain does not pass a longer period of time, it is necessary to urgently consult a dentist in order not to miss the development of osteomyelitis.
It is caused by inflammation that has arisen as a result of tissue damage caused by infection brought about by the flow of blood. Plasma, with its current through the vessels, seizes the infection in the inflamed foci and spreads it throughout the body. This type of disease, most often, develops on the basis of a chronic disease, or a long-term focus of infection. In this case, the inflammatory process goes as if in reverse order: the jaw bone first of all, and then the tooth can be defeated. This type of development of the disease is less common.
Radial osteomyelitis of jaw
Malignant tumor of the maxillofacial region. This diagnosis is not so rare in our time. The doctors have successfully learned to fight this disease. But his insidiousness lies not only in the possibility of returning the disease with the degeneration of cells into cancerous, but also the consequences that a patient has after receiving chemotherapy and radiotherapy.
Radial osteomyelitis of the jaw is a consequence of receiving, in the course of treatment, a large dose of radiation and getting into the focus of the purulent pathogenic infection. The combination of these negative factors leads to the onset of purulent-necrotic processes in the jaw. The probability of the appearance of this lesion largely depends on the stability of the bone tissue to the ionizing radiation directed to it and the negative flora present or absent. That is, everything depends on the possibility of the body, its immune system, to resist the harmful effects from the outside.
More often, the causes of post-radial osteomyelitis of the jaw are considered to be trauma( physical and radiant energy) and infection. Clinical manifestations of the acquired disease - a slow gradual destruction of bone tissue, accompanied by severe pain, with the subsequent appearance of fistula, sequestration. If the patient does not provide medical assistance in time, the consequences can be deplorable. The bone is destroyed so much that there may be pathological fractures of the jaw.
Odontogenic osteomyelitis of the jaws
The most common form of osteomyelitis of the jaw, resulting from serious complications in dental disease( for example, neglected tooth caries).Today, this type of ostiomyitis is diagnosed in more than half of the cases. The disease begins to gain momentum after getting the infection through the carious tissues in the pulp and then to the dental root. After the damage to the root of the tooth, the infection also grabs the nearby jaw tissue. About 70% of lesions belong to the lower jaw. The main damaging bacteria causing this type of disease are both streptococci and staphylococci, and anaerobic bacteria. These pathogenic microorganisms enter the maxillary tissue along the bony ducts, as well as the lymphatic system.
The most common form of osteomyelitis of the jaw is its odontogenic variety, and it is affected by both adults and children of different ages. The cause of its occurrence is an infection that affects the carious tooth. And if you do not promptly seek help from a dentist who removes dead skin, cleans the dental canal and puts a seal, the pathogenic flora in the mouth will trigger the development of inflammation and the formation of a purulent capsule in the jaw bone, which leads todevelopment of odontogenic osteomyelitis of the jaws.
Anatomical features of the jaw are incomparable to any other area of the human body. Due to the teeth, it is in this area that the bone closes as close as possible to the possible source of infection( oral cavity) and a sufficiently small breakdown( caries), so that the virus penetrates to the bone tissue. There is a violation of microcirculation of all processes, the necessary substances and microelements do not enter the tissue, partial cell death begins.
In an inflamed focus, an abscess is formed, provoked by the work of microorganisms such as white or golden staphylococcus, streptococcus and others. Adaptation to drugs and mutations produce a fairly large range of anaerobic flora. This problem can manifest itself in a fuzzy clinic of the disease, in the atypical reaction of a person to medicines and in the manifestation of immunodeficiency.
Also classified by the stage of the disease: subacute, acute and chronic.
The acute form of the osteomyelitis of the jaw is the response of the human body to the penetration of infection into it. Symptoms of this stage are akin to many other diseases, but there are also differences:
- The patient feels weak and malaise.
- Headaches begin.
- There are problems with sleep.
- There is an increase in temperature.
- The appetite disappears. The patient is difficult to eat, as chewing food is accompanied by painful sensations.
- The mucosa of the oral cavity begins to gradually blush.
- Infection affects the immune and metabolic system - this is manifested by an increase in lymph nodes.
- Teeth adjacent to the focus of infection become mobile.
When making a diagnosis, treatment should be started immediately. This stage of the disease is dangerous not only the course of the disease, but also its complications. Especially with this, the spleen and liver suffer.
If the treatment started on time and was maintained at the proper level, the disease passes to another stage - subacute osteomyelitis. At this stage, there are several other manifestations of the disease:
- In the area of damage to the bone tissue, fistulas and dead skin areas form. At this stage there is a partial outflow of pus and fluid - this dulls the severity of the manifestation of symptoms. It seems to the patient that the disease is receding, but the inflammation is gaining momentum, the danger to the body is increasing.
In the future, the disease becomes chronic. This stage of the osteomyelitis of the jaw is the most dangerous:
- . For some time the patient feels almost convalescent. But the disease does not slumber, and remission turns into a new exacerbation of osteomyelitis. There are sequestrants, new fistulas are formed.
Symptoms of the osteomyelitis of the jaw
The main symptoms of this disease are similar to many others, but there are differences, so a diagnosis should only be made by a graduate.
- Some of the symptoms are akin to poisoning: general decrease in vitality, elevated temperature( more than 38 ° C), irritability, poor sleep and headache.
- Acute painful sensations in the field of a caries tooth, the pain amplifies, frequently becomes pulsing at a pulpation.
- Pathological mobility, adjacent to the affected, teeth.
- Redness and swelling of the mucosa.
- Increase in the size of the lymph nodes their soreness when touched.
- A blood test indicates an inflammatory process in the body.
- If the patient did not immediately contact the clinic, the fistula through which the pus flows out may visually differentiate. Painful sensations become dull, but the bone continues to die.
Osteomyelitis of the lower jaw
This disease is the most frequently diagnosed physician in the localization of osteomyelitis in the jaw area. The development of the disease, often occurs due to the ingress through the lymphocytes and bone channels of the pathogenic flora to the bone tissue of the lower jaw. Another way to hit is through the pulp of the damaged tooth.
One of the first manifesting symptoms in it is a decrease in the sensitivity of the receptors of the nerve endings of the lower lip and chin. Significantly increases the sensitivity of the patient's tooth. The pain of touching becomes more acute, pulsating. This all refers to the odontogenic form of the disease.
But the cause, which can cause the development of osteomyelitis can be and trauma of the jaw zone, as well as its fracture - these root causes give impetus to the development of traumatic forms.
And the third type of disease is hematogenous. Infection gets to the focus of inflammation through the blood. The cause of infection of blood can be a simple injection, or a blood transfusion.
For osteomyelitis of the lower jaw, all the manifestations observed in purulent fever are present. There is a general intoxication of the body, there is a chill( especially in the evening), breathing and pulse becomes rapid. At an acute stage of illness, temperature sharply jumps, sometimes approaching critical indicators in 40оС.Painful sensations seem to creep away, grabbing an ever larger area: discomfort increases with chewing, it becomes difficult to swallow.
The severity of this disease is divided into: light, medium and heavy. Distinguish the same, in size, involved in the inflammatory process of the area: diffuse and limited. And as the division goes to the osteomyelitis of the jaw, passed without complications and a disease that entailed significant complications.
Odontogenic osteomyelitis of the lower jaw
Odontogenic variant of this disease, according to medical observations, is encountered much more often than all the others. The lion's share of all cases falls on the odontogenic osteomyelitis of the lower jaw. The disease is caused by a bacterial pathogenic flora that enters the area of pulp and periodontal on the affected canal( tooth channel damage, caries and other tooth integrity disorders), provoking foci of inflammation.
Recently, more and more often pathogens of bone inflammation are obligate-anaerobic flora, until a certain time prevailed such bacteria as white and golden staphylococci, streptococci, a variety of rod-shaped bacteria. ..
But the development of inflammation is not sufficient for the presence of a penetrating infection. The presence of other factors is also necessary: a reduced, for whatever reason, immunity of the patient and, a high degree of ability of this infectious strain of a microorganism or a virus to infect the body. In small children, in connection with a still quite imperfect system of body protection, the scales are inclined, more often, towards illness.
Traumatic osteomyelitis of the lower jaw
It often occurs when a wound or injury caused a fracture of the lower jaw( with the same damage to the upper jaw, such effects do not occur often).Not every inflammatory process after damage to bone tissue can lead to osteomyelitis of the jaw. If the process of inflammation is localized only in the zone of primary damage and does not spread to peripheral zones, it can be classified as focal abscess on the bone. With adequate treatment, started on the nascent stage of the disease, this process is stopped quickly enough and does not degenerate into the dying of bone tissue.
Any break is not manifested in itself. In parallel with him, the patient gets soft tissue damage, a severe bruise. It does not dispense with hemorrhages, which form hematomas. This is a good time for the introduction of the virus and the further growth of phlegmon, or the appearance of an abscess. If timely sanation and open an abscess, support the patient with general restorative therapy, you can in a short time to stop the spread of the inflammatory process, not leading to necrotic manifestations. If the patient receives inadequate treatment or does not receive it at all, then the development of osteomyelitis is very great.
The main cause of traumatic osteomyelitis of the lower jaw is a violation of metabolic processes and microcirculation necessary for the normal functioning of the body. The development of this disease is facilitated, first of all, by the patient's later referral to the doctor, or untimely and incorrect treatment, as well as the concomitant other serious illnesses and non-compliance of patients with oral hygiene.
Osteomyelitis of the upper jaw
Osteomyelitis of the upper jaw, according to medical observations, is much less common, but there are still cases of damage to this disease, so let's consider this case.
Medicine considers several ways of penetrating an infection that affects the upper jaw.
- Hematogenous pathway. Hit the pathogenic flora through the plasma. This can happen with the help of an ordinary injection, as well as in the case of blood transfusions( the virus can be entered with blood if the blood itself was infected, or sterility was violated during the procedure).
- Lymphogenous pathway. Influx of infection through the lymph system.
- Contact or rhinogenic. Penetration comes from the mouth. It can be an inflammatory process that seizes the mucous membrane of the maxillary sinuses( this can happen in chronic or acute rhinitis), as well as the penetration of the pathogenic flora along the gland ducts through the periosteum.
- A newborn can "catch" this disease during labor during the application of forceps, or through infected maternal genitalia. It can happen during feeding, through the nipples( if the mother is suffering from mastitis).Not observing the general hygiene for the baby is fraught with the penetration of infection from dirty toys or nipples, especially during the period when the teeth begin to be cut.
Especially dangerous is the osteomyelitis of the jaw for babies, as the disease develops rapidly and the main thing is not to miss the time, quickly and correctly diagnose, immediately begin treatment. In this category of patients, this disease is more often manifested as an abscess on the basis of sepsis, less often - sepsis develops on the basis of acute RVI( respiratory viral infection).
The main symptoms of the disease, which are the same for both young children and adults, with the only difference that in infants these processes occur more rapidly and with pronounced manifestations:
- This disease in children begins suddenly. The temperature rises sharply up to 39 ÷ 40o C.
- The kid fits, does not want to eat.
- The edema in the area of the nose-cheek-eyes grows.
- During the first days the eye gap is completely closed, the upper lip becomes numb, the nasolabial fold disappears. Lichiko becomes asymmetrical, as if skewed.
- Lymph nodes in the size of the viral lesion increase in size.
- Over the next three days, swelling captures not only the front part, but also the neck.
- The process is developing( in children in the dentition, in adults in the root system of the tooth) suppuration. And there is a rejection of sequestration.
- Due to the edema, the nasal passage narrows or overlaps, which prevents normal breathing. Gradually, it begins to fill with purulent secretions.
- Already in the first - the second day after infection, the skin in the area of swelling acquires a pink shade with a shiny texture. When touching - a sharp pain.
- Already on the first day on the alveolar process, local infiltrates may appear. The mucous membrane becomes hyperemic, softened( bone tissue begins to break down) and increases in size. There is a fluctuation.
- Approximately on the fifth day, a certain amount of sequestration is detected, beginning to appear in the nasal cavity of the fistula. They are formed in the sky, in the area of the inner corner of the eye, in the region of dental rudiments. The upper jaw becomes pathologically mobile.
- Fast enough inflammation and eye sockets. The abscess of the eyelids begins. Any movement causes pain. The eyeball becomes motionless - the phlegm of the orbit develops.
Consequences of complications in osteomyelitis of the upper jaw can be terrible, especially for infants. This and meningitis, sepsis, phlegmon orbits, pneumonia, lung and brain abscess, purulent pleurisy. ..
Acute osteomyelitis of the jaw
Physicians refer to this disease as nonspecific infectious inflammatory diseases. It has a number of characteristic symptoms, some can be both obligate and optional( that is, such symptoms can manifest, or may not be observed).
The body responds to infection in this phase as follows:
- Decreased vitality.
- Pain in the head area.
- Chills appear.
- The temperature can be fixed at 37 ÷ 37.5 ° C or reach 40 ° C( this applies more to children).
- Heart palpitations are gaining.
- Intoxication of the body.
- Reduced blood pressure.
- From the mouth cavity is quite unpleasant smell.
- Mucous is hyperemic, noticeable edema is observed.
- When touching - strong pain.
- There is an outflow of purulent masses from under the gums.
- There may be abnormal mobility of the teeth in the area of inflammation.
The patient's condition at this stage is mild, moderate and severe. Proceeding from this, the doctors prescribe therapeutic measures corresponding to this condition.•
- There is numbness in tissues, their sensitivity is impaired.
- Blood tests show that the body is undergoing an inflammatory process.
- Enlarged lymph nodes. They become painful when touched.
- After removal and dissection of the tooth( first day), purulent discharge intensifies. Improvement of the patient's condition is not observed.
- Only on the second day the patient becomes easier, the inflammation subsides, the amount of excreted pus decreases.
Acute odontogenic osteomyelitis of jaws
Infectious purulent infection of the jaw bones, the source of which is a virus or infection that penetrated into the inflammation focus due to tooth decay, followed by its complication. Infection affects the contact, with further expansion of the affected area and the formation of osteonecrosis( the gradual withering of bone matter).
As a matter of fact, acute odontogenic osteomyelitis of the jaws is nothing more than a complication that appeared when the caries stage was started.
Acute osteomyelitis of the lower jaw
As mentioned above, this disease most often affects the lower jaw. The doctor diagnoses the patient on the basis of a comprehensive examination. Primarily, this is based on a patient complaint and a visual examination by a specialist. Next, "connect" radiography and laboratory tests.
The main symptoms in the acute form are identical, be it traumatic, odontogenic or hematogenous osteomyelitis. The common thing about them is that you should not start the disease and expect the process to "resolve" itself. The earlier a patient begins to provide medical care, the more sparing the therapy will be and the less destructive effects of inflammation on the body.
Acute odontogenic osteomyelitis of the lower jaw
It is this type of disease, as it is not strange, is found most often. Have you started your teeth and are afraid to go to the doctor? Your cowardice can cause illness. Carefully read the symptoms of the disease. Maybe this will help you to visit the dentist.
Chronic osteomyelitis of the jaw
The chronic form of this disease is unpleasant not only due to the symptomatology, but also because the disease can proceed with varying success( sometimes fading, but again exacerbating) for several months. There is a periodic appearance of new fistulas and rejection of necrotic areas of bone tissue. The chronic form requires periodic observation by a specialist.
Chronic osteomyelitis of the lower jaw
The chronic form of the disease is more often ascertained by the end of 4 weeks, when a sequestral is formed, fistulas appear. Patient's state of health is consistently satisfactory. Normalized temperature and protein levels in the blood.
The main reason for the transition from an acute form to a chronic doctor is considered to be the untimely arrest of the acute stage of the disease( tooth extraction. ..).
Chronic odontogenic osteomyelitis of jaws
Most often, chronic odontogenic osteomyelitis of jaws affects children 3 to 12 years( period of cutting and replacing teeth), as well as adults whose mouth, for the most part, is not sanitized.
Diagnosis of mandibular osteomyelitis
Diagnosis should be made only by a specialist! And only after a comprehensive study of the patient was conducted. The main milestones of diagnostics:
- Complaints of the patient.
- Visual inspection of the patient.
- X-ray disturbing area.
- Blood test.
Diagnosis of the disease is based on external symptoms and laboratory findings.
X-ray for osteomyelitis of jaw
At first, it is problematic to identify the disease with fluoroscopy. Only by the end of the first week in the picture it will be possible to consider a diffuse, somewhat transparent spot that indicates a change in bone structure under the influence of purulent exudate.
Treatment of osteomyelitis of the jaw
Treatment of acute illness is based on the disclosure of suppuration, sanitation and drug therapy, which helps to eliminate peak manifestations in the inflammatory focus. The tooth and bone fragments are necessarily removed from the fracture site, but the periosteum should be approached very carefully, it can not be peeled off. The most unpleasant thing in this disease is that it is not possible to completely restore the tissue ligament in its original form. Epithelialize the wound completely does not work, there is a cavity forming a fistula that can not close spontaneously. The patient feels better, the blood counts are normalized.
In this condition, the affected area can exist for a fairly long period of time, spontaneously, as a rule, without closing. The patient feels much better. The composition and blood counts are normalized. And the process gradually turns into a subacute, and then a chronic form.
Follow-up medical care is aimed at mobilizing the body's immune system. During this period, the formation of sequesters is taking place, and bone callus is formed.
Treatment of mandibular osteomyelitis
As the long experience shows, most often the lower jaw is affected.
Treatment of this disease begins, first of all with sanation with solutions of oral antiseptic and wound cavity, in order to avoid re-infection of the source of infection. Then proceed to anti-inflammatory therapy.
- It is necessary to "cleanse the body" by taking measures to remove intoxication.
- Eliminate adverse factors affecting metabolic processes in the body, and more specifically at the site of inflammation.
- There is a need to stimulate repair and effective work of reparative processes.
The physical procedures are also connected. For example, the use of the apparatus "Plazon", which promotes the healing of wounds and the suppression of inflammatory manifestations, using exogenous nitric oxide.
- The treatment procedure using NO-therapy is well known. The advantages of its use also do not cause doubts:
- The overwhelming effect on parasitic bacteria.
- Stimulation of phagocytosis, responsible not only for the destruction of foreign body particles, but also the absorption of that biomaterial, which under certain situations can become so.
- Works on improving blood microcirculation.
- Normalizes the conductivity of nerve endings.
- Regulates immune processes.
- Activates secretions that promote faster wound healing and elimination of inflammatory manifestations.
- Stimulates the synthesis of collagen( connective tissue).
- Strengthens epithelization - spontaneous overgrowing of a skin or mucous membrane wound with epithelium, closing this defect.
Treatment of maxillary osteomyelitis
If the infection enters the ethmoid and maxillary sinuses with a hematogenous pathway in case of a mother's disease( mastitis, sepsis), orbital complications occur somewhat later than apparent symptoms of the maxillary osteomyelitis.
On the roentgenogram the blurred structure of the jaw is clarified with enlightenment in the first days of the disease and the disappearance of the bone structure with the formation of a sequester at a later stage of the disease.
It is absolutely necessary to remove the tooth in the osteomyelitis of the jaw, since the infection tends to spread to other healthy tissues, after which the process is much more difficult to stop. After removal, the doctor prescribes an early periosteomy. This procedure involves an incision of the periosteum for the free removal of the fluid that results from the development of infection and the death of exudate tissue. Also, the doctor prescribes a course of antibiotics and washing the cavity of the infected bone with antiseptic solutions. In addition, symptomatic treatment is prescribed. In severe cases, sequestrants are surgically removed. Necessarily appoint antibiotics and detoxification therapy( directed against poisoning the body).
Treatment of osteomyelitis of the jaw folk remedies
It must be warned that this disease must be treated only medically. The following recipes are only able to help the body fight the disease.
- Tincture of a walnut.200g of septums from a nutshell pour 500ml of vodka. Infuse two weeks in a dark place. Strain. Eat 1 tbsp.l.in a day.
- Drink one raw egg from 1 tbsp.l.fish oil twice a day.
- In a liter jar pour vodka flowers of lilac. Put for a decade in a dark place. Drink three times a day for 30 drops or apply to the sore spot compresses.
Treatment of chronic osteomyelitis of the jaw
If the disease term is within 1.5 months - conservative methods are most often used in treatment. It is the reception of antibiotics with parallel stimulation of immune processes. Such treatment is effective for local chronic osteomyelitis, not prone to expanding the inflammatory zone.
If the disease has crossed within 1.5 months and there are already non-absorbable sequestrants, and the appearance of fistulas does not stop, violations in the work of the kidneys begin to appear - these are indications for surgical intervention, that is, the doctor carries out sequestration removal. In the preoperative period, the patient receives therapy that supports the resistance of the body( ability to heal wounds).After the operation, antibiotics, vitamins, and physiotherapy are prescribed.
Treatment of chronic mandibular osteomyelitis
Mandatory removal of the diseased tooth and the formation of cuts on the periosteum to improve the outflow of fluid and sanitation with antimicrobial agents of the bone cavity.
With this disease, unambiguous introduction to the course of treatment of antibiotics, which can last from 10 to 24 days, and general rehabilitation measures can last for several months. Some doctors recommend hyperbaric oxygen to their patients( especially after irradiation of the lower jaw).
Antibiotics for osteomyelitis of the jaw
In this disease, antibiotics are attributed unambiguously. They are administered intramuscularly or intravenously. But in very difficult cases, the patient receives them intraarterially, endolymphically. The most commonly used penicillin or clindamycin.
Pinicylin is intramuscularly rapidly absorbed into the plasma. It is introduced from the calculation that in 1 ml of blood there was 0.1-0.3 units of penicillin. For effective treatment, it must be administered every 4 hours.
Clindamycin. Adults are assigned 150 ÷ 50 mg.every 6 hours. The course duration is individual for each patient, but not less than 10 days. For babies over 1 month, the daily dose of 8 ÷ 25 mg / kg.body weight.3 ÷ 4 reception. Babies over 1 month of medication are administered a dose of 20 ÷ 40 mg / kg.body weight per day.
To speed up the healing process, the patient is prescribed methyluracil in a dosage of 1 tablet three times throughout the day( treatment course 10 ÷ 14 days), as well as vitamins C( daily dose 1 ÷ 2 g with a weekly course), B1, B6( 2 ml 5% solution every other day) and A. The protocol of treatment also includes plasma transfusion( portioning), physical procedures and nutrition.
Prevention of osteomyelitis of the jaw
In any situation, preventive measures are capable, if not completely prevent the disease, then able to make it less destructive for the body. A person who is very careful about his health is guaranteed, most significantly, protected from severe consequences, even if his illness is still overtaken.
No exception and osteomyelitis of the jaw. For the most part, if this is not hematogenous osteomyelitis( which the patient neither foresees nor warns), preventive measures are not so complicated.
- It is necessary to adhere to simple rules of personal hygiene( brush your teeth in the morning and in the evening, wash your hands before eating. ..).
- At the slightest discomfort in the oral cavity( teeth, gums. ..) it is necessary to consult a dentist. Do not pull with the campaign. Caries should be treated in a timely manner. Do not delay prosthetics, if necessary.
- Do not neglect and infectious diseases of the upper respiratory tract.
- Be careful and circumspect. Do not allow injury to the face( jaw).
Forecast of osteomyelitis of the jaw
If the patient promptly turned to a clinic to a specialist, then the prognosis of the osteomyelitis of the jaw doctors give predominantly positive. If the patient was admitted to the hospital in an acute form of the disease course, then it is difficult to predict anything unambiguously. After all, it is not known how the body will work, as far as it has enough of its internal strength in the fight against the disease. Complications that may occur during treatment are diverse.
- Septic shock may occur as a consequence of body intoxication.
- Acute pulmonary insufficiency.
- Purulent infection can lead to phlebitis of facial veins.
- Pulmonary and cerebral abscesses.
- Meningoencephalitis and meningitis.
- Greater chance of developing sepsis.
- Many of the above diagnoses can lead to death.
- Also, with significant bone lesions, there is a possibility of a pathological fracture or false joint, which always leads to jaw deformation.
Having carefully studied the topic of the article, you can learn a lot about osteomyelitis of the jaw. The main thing is to make the right conclusions for yourself. In any situation, preventive measures come out on the first place, which will help to save you from this rather unpleasant and insidious disease. You just need to live and rejoice, but it's necessary to organize your life unobtrusively so that the activities mentioned above become an integral part of your existence. If the disease still made itself felt, call an ambulance or immediately consult a doctor. Only a specialist will be able to correctly diagnose and attribute effective treatment. Timely treatment in the clinic will not only prevent the disease at an easier stage, but it can save your life.
Osteomyelitis of the lower and upper jaws
Subacute osteomyelitis of the jaw , which in most cases develops after acute osteomyelitis, is characterized by a breakthrough of pus from the bone tissue outwards through the fistula( in most cases into the oral cavity), with destruction of the bone andThe inflammatory process continues, although the general condition of the patient is somewhat improved.
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Chronic osteomyelitis of the mandible is characterized by a prolonged( up to several months) inflammatory process in the jaw, which indicates the formation of sequesters( these are areas of necrotic and rejected bone tissue) with the formation of new fistulas, while the general condition of the patient improves.
Jaw obstruction of the jaw
The main complications of osteomyelitis of the jaw that develop without adequate and timely treatment include:
- abscess( localized purulent inflammation);
- phlegmon( a common purulent inflammation affecting the soft tissues of the neck and face);
- sepsis( infection in the blood with the development of a life-threatening condition);
- contracture( characterized by a decrease in the mobility of the jaw);
- pathological fracture of the jaw.
Diagnosis of mandibular osteomyelitis
Diagnosis is made on the basis of patient complaints, general and local examination, which is supplemented by blood tests, X-ray examination of the jaws.
Treatment of the osteomyelitis of the jaw
Treatment of this pathological process implies:
- mandatory removal of the affected tooth;
- course of antibiotic treatment;
- surgical intervention( consists in the dissection of the periosteum, which provides an outflow of pus and inflammatory fluid from the affected tissues and the possibility of washing the bone cavity with various highly effective antimicrobial agents);
- course of detoxification therapy;
- topical therapy;
- splinting( with menacing jaw fracture).
In case of timely treatment, the postoperative period proceeds without any peculiarities, whereas in severe and neglected cases recourse is made to repeated operations and the combination of various surgical techniques.
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en-dent.comMay 24th at 22: 2526830 Osteomyelitis - an infectious disease of bone tissue, usually caused by bacteria, and in some cases pathogenic fungi. Osteomyelitis of the jaw bones is 1.5-9% of cases of surgical dental pathology. In more than 80% of patients, the jaw bone osteomyelitis is odontogenic in origin. Osteomyelitis of jaws of other origin( traumatic, specific, etc.) make up no more than 15-20% of cases. Odontogenic osteomyelitis of the jaws is the main cause of the temporary disability of patients with dental profiles who are on an outpatient treatment, and in hospitals 30 to 40% of specialized dental beds are occupied precisely by patients with this pathology. Among the osteomyelitis of other human bones, the proportion of jaws accounts for 37-40% of all forms of this pathology, and the percentage ratio between lesions of osteomyelitis of jaws and other bones has not changed significantly in recent years.
Acute osteomyelitis of the jaw bonesAcute osteomyelitis of the jaw bones - suppurative inflammation of the jawbone and its bone marrow with development of the areas of osteonecrosis.
EpidemiologyThe most commonly affected individuals are 20 to 40 years old( they account for more than 50% of all cases).About 18% of cases are in elderly patients, 8-9% in children under 10 years old.
Etiology and pathogenesisThe etiology distinguishes: odontogenic, hematogenous and posttraumatic osteomyelitis. The path of infection is from the cavity of the tooth decayed to the bone( odontogenic);with blood flow from distant areas of inflammation - traumatic skin and mucous membrane damage, omphalitis, etc.(hematogenous);from the line of fracture of the jaw bone communicating with the external environment( posttraumatic).X-ray examination in the early days of the disease does not reveal signs of changes in the jaw bones. By the end of the first week there is a diffuse depression of the bone, indicating its melting with purulent exudate. Within 3-4 weeks, the destruction of bone is increasing. At the same time, a productive reaction appears in the form of periosteal and endosteal bone formation. This leads to thickening of the bone, condensation of its structure and gradual disappearance of the sites of destruction. After 4-6 months, excess endosteal and periosteal stratifications dissolve, the bone acquires the usual shape and structure.
Clinical signs and symptomsThe disease begins acutely, body temperature rises to 38-39 ° C, chills, weakness and malaise. In young children, as the temperature rises, convulsions, vomiting and abnormal gastrointestinal function occur. Around the destroyed tooth appears diffuse inflammation, pathological mobility of its and adjacent teeth, pustules from the dentogingival pockets. In the tissues surrounding the jaw, collateral edema develops, abscesses, phlegmon, lymphadenitis. On the upper jaw, the maxillary sinus, the eye socket, the middle ear can be involved in the process. The younger the child, the more severe the disease is. Complications. Later, seeking medical help and delayed treatment contribute to the generalization of bacterial inflammation, up to the development of sepsis, the spread of purulent process in the cell spaces of the head and neck, and mediastinum.
Diagnosis and recommended clinical trials ofThe diagnosis is based on clinical and radiological examination. It is necessary to pay attention to anamnesis, complaints of the patient, the presence of functional disorders. X-ray images are performed in several projections. Characteristic features of the jaw osteomyelitis:
- marked intoxication;
- clinical and laboratory signs of purulent-necrotic inflammation of the jaw bone structures and adjacent soft tissues;
- X-ray signs of purulent-necrotic inflammation of the jaw bone structures and adjacent soft tissues( see "Etiology and pathogenesis").
- general urinalysis;
- bacteriological examination of blood( to exclude sepsis);
- bacteriological examination of detachable dentogingival pockets, the contents of drained abscesses in order to identify the pathogen and determine its sensitivity to antibiotics.
Differential diagnosisAcute odontogenic osteomyelitis of the jaw bone differentiated acute purulent periostitis( presence subperiosteal abscess on one side of the alveolar process, the mobility of a "causal tooth") to malignant tumors of jaw bones( no "causal tooth" on the radiograph - lysis of the cortical bone of the jaw, degradation hearthbone tissue with fuzzy contours).
Clinical recommendationsEmergency hospitalization and urgent surgical care are shown in full. Conservative therapy is prescribed for 10-12 days.
Surgical treatmentSurgical care should be provided in its entirety and include the removal of the "causal tooth", the opening of pus accumulation foci, and their drainage. With a strong destruction of the crown of the "causal tooth" and the severe condition of the patient, a delayed removal of the crown after deletion of inflammation occurs.
Antimicrobial Therapy Antimicrobial therapy begins with the assignment of broad spectrum antibiotics which are cumulated in the bone tissue( lincomycin, ceftriaxone et al.). After receiving data on the sensitivity of the flora to antibiotics, a correction of antibacterial therapy is performed: Lincomycin inside 500 mg( adults);10 mg / kg( children) 2-3 days, 10-14 days or Cefazolin IV or IV 500 mg( adults and children over 12 years old);10-20 mg / kg( for children) 2 days, 10-14 days or Ceftriaxone IV or IM 1-2 g( adults and children over 12 years);20-80 mg / kg( children under 12 years) 1 p / day, 10-14 days. In severe disease: Lincomycin IM 600 mg 1-2 r / day or IV 600 mg( adult);10-20 mg / kg( children) every 8-12 hours, 10-14 days or Ceftriaxone IV or IV 3-4 g 1 day, 10-14 days.
antihistamine therapy to provide an antiallergic and desensitizing action throughout the course of antibiotic therapy used antihistamine drugs: Clemastine into 0.5 mg( children 6- 12 years);1 mg( children over 12 years and adults) 2 days 10-15 days or Loratadine inside 10 mg( adults);5 mg( children) 1 p / day, 10-15 days or Mebhydrogen inside 50-100 mg / day in 1-2 doses( children under 2 years);50-150 mg / day in 1-2 doses( children 2-5 years);100-200 mg / day in 1-2 doses( children 5-10 years);on 50-200 mg 1-2 r / day( children over 10 years and adults), 10-15 days or Hifenadine inside after eating 0.025-0.05 g 3-4 r / day( adults);0,005 g 2-3 r / day( for children under 3 years);0,01 g 2 r / day( children 3-7 years);0,01 g or 0,015 g 2-3 r / day( children 7-12 years old);0,025 g 2-3 r / day( for children over 12 years), 10-14 days or Chloropyramine inside 0.025 g( adults);8.33 mg( children under 7 years);12.5 mg( children 7-14 years) 2-3 days, 10-14 days or Cetirizine inside 0.01 g( adults and children over 6 years old);0,005 g( children under 6 years) 1 p / day, 10-14 days.
analgesic and antipyretic therapyanalgesic and antipyretic drugs administered if necessary: inwardly Analgin 500 mg 1-3 p / day or 25-50% solution w / w or w / o 1-2 2-3 ml of p / d, prior to clinical improvement, or Baralgin / Pitophenone / fenpiperinium bromide oral 500 mg / 5 mg / 100 μg 4 r / day or IM / ml 2 ml to 1-3 r / d, prior to clinical improvement or Paracetamol, oral 10 mg/ kg( children under 6 years);0.2-0.5 g( children over 6 years and adults) 2-3 r / day, until clinical improvement.
Detoxification therapyDetoxication therapy is performed until the symptoms of intoxication disappear: Dextran, average molecular weight 30 000-40 000, IV drip 200-1000 ml 1 p / day, before clinical improvement or Sodium chloride, 0.9% rp, IV droplet( 180 drops per minute) 200-1000 ml 1 p / day, before clinical improvement or Polyvidone / sodium chloride / potassium chloride / calcium chloride / magnesium chloride / sodium hydrogen carbonate2 intravenously(40-80 drops / min) through a system with a filter of 200-500 ml 1-2 r / day, until the clinicalbeams.
Immunotherapy Immunotherapy is carried by indications: Cat's claw inside for 30 minutes before meals one capsule 3 r / day, or 15-30 days TSikloferon / w or w / o 0.25 g of 1 p / day, 2 days, then every other day, 10-60 days.
VitaminotherapyIn complex treatment of acute osteomyelitis vitamins are also used: ascorbic acid( for the purpose of regulating oxidation-reduction processes, stimulating tissue regeneration, activating phagocytosis and synthesizing antibodies) and thiamine( participates in oxidative decarboxylation of keto acids, carbohydrate metabolism and associated energy, fat, protein, water-salt metabolism, is necessary for the synthesis of acetylcholine, has a regulating effect on the trophic and the activity of the nervous system): Ascorbic acid inside50-100 mg 3-5 r / day or 5% rr in / m 1 ml 1 p / day, 20-40 days + Thiamine inside 0,01 g 1-3 r / day or 2,5-6% rr in / m 1ml 1 p / day, 10-30 days. Polyvitamin complexes are also used. To purify the wound from purulent necrotic masses, proteolytic enzymes are used: Trypsin 5 mg( in isotonic sodium chloride solution) locally 1 p / day, until clinical improvement.
Antiseptic therapyTo disinfect wounds, chlorhexidine solution is used: Chlorhexidine, 0.05% rr( children 0.02%), topically on affected areas 1 p / day, until clinical improvement.
- ultra high frequency magnetic field( UHF MP) in the phase of suppurative exudation after surgery to accelerate the rejection of necrotic masses and resorption of the inflammatory infiltrate. In a low-heat dose, the power is up to 40 W, 6-10 procedures daily;
- electric field( EP) UHF in an athermic dose of 7-10 minutes with an output power of 5-20 W, 8-10 days;
- ultraviolet( UV) irradiation: anti-inflammatory tissue desensitization, activation of phagocytosis and metabolism. After opening the abscess - bactericidal and dehydrating action. Assign 4-6 bio-doses, adding after 1-2 days for 1 biodosome. The course of treatment is adjusted to 10-12 bioadoz.
Evaluation of the effectiveness of treatmentTreatment is considered effective in the case of the abatement of inflammatory phenomena within 4-6 days after the provision of emergency surgical care and the appointment of a complex of conservative therapy.
Complications and side effects oftreatment It is possible to develop allergic reactions to drug therapy.
Errors and unreasonable prescriptions
- Surgical care rendered in incomplete volume( unreasonable desire to preserve the "causal tooth", incomplete sanitation of the oral cavity, inadequate antibiotic therapy without taking into account the data on sensitivity to antibiotics).
- Incorrectly performed differential diagnosis in tumors.
ForecastWith a timely begun rational treatment, the outlook is favorable. The transition of acute osteomyelitis into a chronic form is possible. G.M.Barer, E.V.Zoryan