Osteomyelitis

Question 1

Considerable factors affecting osteomyelitis

Answer 1

:

Bone

1. Virulence of MO.
2. Host resistance.
3. Anatomic location.
4. Patient age (extremities of age).
5. Pre-existing systemic factor→ Paget’s disease of bone,

sickle cell anemia, and irradiation, osteopetrosis.

6. Immunocompromised status → alcohol abuse, drug abuse, DM, AIDS, malnutrition, malignancy.

Question 2

Changes on symptoms from acute to chronic osteomyelitis

Answer 2

• pain becomes variable
• no trismus
• there is still mild pyrexia
  Pus
• lymphadenopathy
• leukocytisis
• lip papathesia
• cyclic exacerbation
  Commonality
  Sequestrum
  -if involved periosteum
  ..sinus and fistula
  ..swelling tenderness redness of skin and mucosa
  ..periodontitis and mobility

Question 3

Chronic supp osteomyelitis xray

Answer 3

Ill defined

Mottled ro

Question 4

Histology of acute osteomyelitis ?

Answer 4

• perulent exudate in marrow space
• increase osteoclastic activity
• cut of blood supply creates sequestrum which if long standing becomes involucrum

Question 5

Histology of chronic osteomyelitis

Answer 5

- marrow
..vasodilation 
..exudate and edema
..less purulent exudate
..necrosis of marrow
..fibrosis for repair
.. chronic inflammatory cells
- trabeculae
..involuctrum sequestrum 
.. osteoplastic and clastic 
.. reversal lines
.. loss of osteocytes and osteoblasts
..

Question 6

Ttt of chronic osteomyelitis

Answer 6

1- Selective antibiotic & pus drainage.

2- Sequestrectomy, surgical removal of sinus tract.

3-Hyperbaric oxygen in resistant cases which stimulate:

1. Vascular proliferation.
   ii. Collagen synthesis.
   iii. Osteogenesis.

o Hyperbaric oxygen→ special room with 100% oxygen at 2 atmosphere 2h/day

for several weeks.

o Contraindicated in:

1. Viral disease.
   ii. Lung disease.
   iii. Optic neuritis.
   iv. Residual, recurrent malignancy.

Question 7

Condensing ostitis response to rct

And marrow condition

Answer 7

• remain on xray even after extraction or rct

- fibrosis with chronic inflammatory cells

Question 8

Chronic sclerosing osteomyelitis etiology

Answer 8

• inflammatory reaction to low virulence micro organism

Creating hypersensitivity reaction and is associated with chronic periodontitis

Question 9

Diffuse S O clinical

Answer 9

-black females middle age
- vague pain
- if acute exacerbation
..pain
..swelling
.. pus formation
- positive microbiological culture

Question 10

Diffuse S O xray

Answer 10

-ill defined ro
Bi
May involve 4 quadrants

Question 11

Diffuse sclerosing osteomyelitis histology

Answer 11

• fibrosis and chronic inflammatory cells in marrow
• osteoclastic and blastic
  Mosaic pattern of reversal lines

Question 12

Ttt of diffuse sclerosing osteomyelitis

Answer 12

• pamidronate
• low dose corticosteroids
• decortication of affected area
• periodontitis treatment
• antibiotics with acute exacerbation

Question 13

Etiology of garry’s osteomyelitis

Answer 13

Periosteal inflammation and proliferation with chronic osteomyelitis associated with periapical abscess or partially erupted molars or following tooth extraction

Question 14

Clinical of garre’s

Answer 14

Asymptomatic or mild pain. 2. Unilateral bony hard swelling.

3. Normal l appearance of overlying skin and

mucosa.

4. Age → mainly in children.
5. Site-lower molars, mainly 18 molar or

following extraction.

Question 15

Xray of garre’s

Answer 15

Periapical film- radiolucent lesion

which is centrally mottled.

o in occlusal film- expanded cortex with

parallel opaque layers perpendicular to

R/F

cortex (onion skin appearance).

Question 16

Histology of garre’s

Answer 16

peripherally-osteoblastic activity new subperiosteal and supracortical deposition of woven bone trabeculae perpendicular to

cortical bone Osteoblastic and osteoclastic activity is seen

H/P

Chronic inflammatory cells and fibrosis in

bone marrow.

Question 17

Chronic tendoperiostitis

Answer 17

Chronic inflammation of periosteam & tendons of muscles. Inability to relax jaw muscles due to habits as bruxism, clenching, nail biting & psychogenic stress.

1-age mean age 40 years.

2-Swelling of check & recurrent pain.THT Pain

3-Trizmus.

4- Negative microbiologic culture → non

responsive to antibiotics.

1- Bone sclerosis (radio opaque area) anterior to mandibular

angle at attachment of masseter muscle.

2 Bone erosion at inferior border of mandible anterior to

mandibular angle.

C/P

1-Sclerosis, remodeling of cortical and subcortical bone at musc

attachment1 bone volume.

2- Inflammatory cells in resorbed areas.

Ttt
..analgesia and corticosteroids 
..night guard
.. intra oral decortication may be done 
..

Question 18

Precipitating factors of osteoradionecrosis

Answer 18

Add 
Surgery
Scaling 
Periodontal disease
Periapical abscess

Question 19

Symptoms of osteoradionecrosis

Answer 19

-radiation induced mucositis
- radiation induced caries
- dry mouth
Sequestration

Question 20

Histology of osteoradionecrosis

Answer 20

• sequestrum
• narrowing of blood vessel by fibrous tissue
• destruction of osteoblasts
• chronic inflammatory cells

Question 21

Precautions for osteoradionecrosis

Answer 21

Any un restorable tooth should be extracted two weeks prior to radiation therapy

If radiation was less than 6500 rad could extract after radio by 1y with penicillin coverage for 5 to 7 d

Treated by hyperbaric o2 and antibiotics
Avoid o2 if there is residual tumor