Osteomyelitis of the jaw is a dangerous inflammatory disease that is caused by infection. A purulent-necrotic process develops on the tooth bone - most often on the lower jaw. Next, the inflammation affects the bone tissue of the head and spreads to soft tissues - gums, salivary glands, skin, chewing and facial muscles. In severe cases, pus forms and necrosis of bone tissue occurs.
If the process turns into purulent inflammation of the soft tissues of the face, the patient suffers not only from local inflammation of the bone, but also from general intoxication.
Inflammatory processes in the mouth do not always develop into osteomyelitis. This disease most often affects people with weakened immune systems.
What is it and how to treat it?
Osteomyelitis is an inflammation of the bone marrow with a tendency to progress.
This is what distinguishes it from the widespread dentoalveolar abscess, dry socket, and osteitis seen in infected fractures. Osteomyelitis affects adjacent cortical plates and often periosteal tissues. In the era of preantibiotics, osteomyelitis of the mandible was not uncommon. With the advent of antibiotics, the disease began to be detected less frequently. But in recent years, antimicrobial drugs have become less effective, and the disease has reappeared.
Alveolitis
Inflammation of the walls of the socket.
- In the initial stage of alveolitis, an intermittent aching pain appears in the socket, which intensifies while eating;
- The general condition is not disturbed, the body temperature is normal;
- The tooth socket is only partially filled with a loose, disintegrating blood clot.
With further development of inflammation:
- The pain intensifies and becomes constant;
- Transmitted to the ear, temple, corresponding half of the head;
- The general condition worsens, malaise and fever appear.
Osteomyelitis of the jaw. Causes
In the maxillofacial region, osteomyelitis occurs mainly as a result of the continuous spread of odontogenic infections or as a result of trauma. Primary hematogenous osteomyelitis in the maxillofacial region is rare, usually in very young people. Thus, osteomyelitis of the jaw occurs after tooth extraction, root canal treatment, or with fractures of the upper or lower jaw. This initial lesion leads to an inflammatory process caused by bacteria.
The incidence of osteomyelitis is much higher in the mandible due to the dense, poorly vascularized cortical plates and blood supply. Osteomyelitis of the maxilla is much less common due to the excellent blood supply from several feeding vessels. In addition, the maxillary bone is less dense than the mandibular bone.
Reduced patient protection, both local and systemic, may significantly contribute to the development of osteomyelitis. Osteomyelitis can be associated with a variety of systemic diseases, including diabetes, autoimmune conditions, malignancies, malnutrition, and acquired immunodeficiency syndrome. Medicines associated with the risk of osteomyelitis: steroids, chemotherapy drugs, bisphosphonates. Radiation therapy (causes so-called radiation osteomyelitis of the jaw), osteoporosis and bone pathology can change the blood supply to this area and become a potential springboard for the development of osteomyelitis.
Classification
According to the method of penetration of osteomyelitis infection on both jaws, a classification has been compiled:
- Hematogenous - pathogenic microorganisms move through the blood from other foci of infection. This feature is characteristic of secondary pathology of the upper oral part, which develops against the background of another disease (scarlet fever, diseases of the ENT organs). The bone elements of the oral apparatus are primarily affected, followed by the gingival tissue.
- Odontogenic – infection comes from a tooth, damaged pulp or root (pulpitis, periodontitis, cyst, alveolitis).
- Traumatic – advanced fractures and injuries of the maxillofacial area.
According to the symptoms, the process happens:
- spicy;
- subacute;
- chronic.
By distribution:
- local (with clear boundaries);
- vague (diffuse).
Osteomyelitis of the jaw. Symptoms
Like any infection of the maxillofacial area, osteomyelitis of the lower jaw and osteomyelitis of the upper jaw are accompanied by symptoms:
- pain
- swelling and redness on the surface of the skin
- adenopathy
- heat
- paresthesia of the inferior alveolar nerve
- lockjaw
- malaise
- fistulas
Pain from osteomyelitis is often described as deep and aching, which often does not correspond to the clinical picture.
In acute osteomyelitis, swelling and erythema of the overlying tissues are very often observed, which indicate the initial phase of the inflammatory process in the underlying bone.
Fever often accompanies acute osteomyelitis, whereas it is relatively rare in chronic osteomyelitis.
Inferior alveolar nerve paresthesia is a classic sign of pressure on the inferior alveolar nerve as a result of an inflammatory process in the bone marrow of the mandible.
Trismus may be present due to an inflammatory reaction in the muscles of mastication.
The patient usually experiences malaise or a feeling of general weakness, which can accompany any systemic infection.
Finally, both intraoral and extraoral fistulas are usually present in the chronic phase of maxillofacial osteomyelitis.
Complications
If you see a doctor in time, make a diagnosis and choose the right treatment, the prognosis will be favorable.
If you ignore all the conditions, complications will arise:
- Meningitis
- Abscess of the brain and lung.
- Orbital phlegmon.
- Sinusitis.
- Vein thrombophlebitis.
- Sepsis.
- Mediastinitis.
Pathological data require immediate assistance to prevent death.
The chronic process, with its long course, affects the soft tissue and bone areas of the maxillofacial area, and is accompanied by:
- traumatization;
- changes in the TMJ;
- the formation of adhesions in the joints and scars on the masticatory muscles;
Such disorders limit chewing movements or lead to immobility.
Osteomyelitis of the jaw. Diagnostics
Patients are often given laboratory tests as part of their initial evaluation. In the acute phase of osteomyelitis, leukocytosis with a shift to the left is often observed, which is typical for any acute infection. But leukocytosis is relatively rare in the chronic phases of osteomyelitis.
The patient may also have an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Both ESR and CRP are very sensitive. Almost all patients will undergo maxillofacial imaging.
Computed tomography (CT) has become the standard of care in the evaluation of maxillofacial pathology such as osteomyelitis. It provides a three-dimensional image. CT can provide very detailed images of early cortical bone erosion in osteomyelitis. Often, along with pathological fractures, you can see the degree of damage and bone sequestration. CT scanning, like conventional X-ray examination, shows changes when bone demineralization reaches 30 to 50%, which significantly delays the diagnosis of osteomyelitis. Magnetic resonance imaging (MRI) is generally considered more valuable in assessing soft tissue lesions in the maxillofacial region. However, MRI can help in the early diagnosis of osteomyelitis. Thus, MRI can help in identifying the early stages of osteomyelitis.
Secondary chronic
In children, rapid chronic inflammation is noted. After 3 weeks, acute symptoms disappear, but the child does not become healthier.
When it comes to chronic inflammation, there is an active process of destruction, as well as melting of the elements of bone substance. After which areas of necrosis form. In addition, thanks to the intraosseous structures and periosteum, bone tissue is actively restored. The peculiarity of this type of osteomyelitis is the presence of the rudiments of permanent teeth. If they are involved in pathology, they may then die, and their behavior will resemble sequestration.
Symptoms of chronic osteomyelitis
When the inflammatory process becomes chronic, acute symptoms decrease. 10 days after the disease began, the child feels better (appetite and sleep return to normal, fever and symptoms of intoxication disappear). But children still feel weak, they get tired quickly, they sweat profusely, and their skin is pale. Sometimes children say that their jaw hurts slightly on the side that is affected.
During the examination of such a patient, you can notice certain manifestations of the inflammatory process:
- over the place where the focus of osteomyelitis was, there are soft tissue infiltrates;
- pain is felt when the child's jaw is probed;
- There are fistulas in which pus is released. They can be multiple or single;
- lymph nodes in the neck and jaw increase in size and hurt;
- The sockets of the tooth that were removed do not heal well. It may also leak pus;
- teeth are very loose.
When the disease worsens, the symptoms resemble acute osteomyelitis.
Diagnosis of chronic osteomyelitis
An x-ray should be taken to confirm the diagnosis. It will allow you to see the foci of destruction, those rudiments of teeth that have died, sequestration. If the lesion is extensive, then jaw fractures may even be detected.
Treatment of chronic osteomyelitis
When it comes to secondary osteomyelitis of a chronic form, a conservative treatment method is used:
- antibiotic therapy. Which drugs are suitable? All this is determined after the patient undergoes a culture of the pus discharged from the fistulas. Thus, the type of microorganism that provoked the pathology and its sensitivity to different drugs will be determined;
- desensitizing therapy. This includes antihistamines, which will remove the allergic reaction and also increase the body's resistance;
- therapy that can be used to stimulate the immune system and strengthen the body as a whole;
- physiotherapy. For this purpose, UHF therapy and laser irradiation are performed.
To perform an osteotomy or sequestrectomy, you must have the following indications:
- sequesters that are large in size and do not undergo spontaneous lysis for a long time;
- there are rudiments of permanent teeth that have died. They support inflammation;
- there was a risk of amyloidosis of internal organs.
If the disease worsens, the treatment will be identical to that in the case of acute osteomyelitis. But the main method is surgical intervention, during which lesions with pus are opened and drainage is performed.
Osteomyelitis of the jaw. Treatment
The first step in treating osteomyelitis is to correctly diagnose the condition. A preliminary diagnosis is made based on clinical assessment and radiological examination.
Treatment of osteomyelitis of the maxillofacial region requires both conservative and surgical methods. In later stages, antibiotic therapy is rarely effective, so the vast majority of cases of osteomyelitis require surgery.
For osteomyelitis of the upper or osteomyelitis of the lower jaw, as a rule, classical treatment is used - sequestrectomy. The goal is to remove necrotic or poorly vascularized bone sequestration in the infected area and improve blood flow. Sequestrectomy involves removing infected and avascular pieces of bone—usually cortical plates—in the infected area. Visual assessment is critical at these stages, but radiation diagnostics, which shows the osseous extent of the pathology, also helps. It is often necessary to remove teeth adjacent to the area of necrosis.
Supporting the weakened area with a fixation device (external fixator or reconstruction plate) is often used to prevent pathological fracture.
Recovery after surgery
No hospitalization
We do not use general anesthesia, which often leads to complications and requires a hospital stay of 1-3 days. Sedatives for immersion in medicated sleep have no effect on the body and are completely eliminated after 30-40 minutes.
A low-traumatic ultrasound protocol in combination with microscopic surgery, performed by experienced maxillofacial surgeons, allows you to avoid trauma and perform the operation as carefully and delicately as possible.
When you contact our Center, you will spend the first night after the operation at home.
Accelerated rehabilitation
Recovery after surgery occurs within a week. For those who want to speed up the process, we offer our own accelerated rehabilitation program to eliminate pain, bruises and tissue swelling on the day of the visit:
Home care
After surgery, medication is prescribed to relieve pain and prevent inflammation. A course of antibiotics is prescribed separately. You will receive the entire package of drugs free of charge to prevent the purchase of counterfeit products.
All necessary medications and instructions with rules of behavior for the rehabilitation period are issued immediately after the operation
Please do not skip taking medications, treat the operated area and follow the rules of behavior during the rehabilitation period - the instruction is in the bag with the medications.
1.5-2 weeks after the operation, we will invite you to remove the sutures and take a control CT image to assess the condition of the sinus and bone.
Preventive actions
Prevention is important not only to prevent the development of purulent inflammation, but also to minimize the likelihood of complications. With the help of preventive measures, you can also speed up rehabilitation if it was not possible to prevent the disease:
- Timely elimination of carious formations, even if there are no clinical symptoms.
- Sanitation of various foci of infection.
- Physical activity, a balanced and nutritious diet, which contribute to the effective functioning of the immune system.
- Compliance with the doctor’s recommendations after injury, during recovery after surgery or tooth extraction.
In conclusion, I would like to emphasize that although modern medicine has made great progress, osteomyelitis of the jaw bone still remains a serious problem. Thanks to the timely detection of symptoms of pathology and proper treatment, it is possible to significantly increase the likelihood that the patient will be able to fully recover and the quality of his future life will not be affected.