Osteomyelitis of the jaw: causes, symptoms and treatment in an article by orthopedic dentist Dunaevskaya N.V.

Classification

Osteomyelitis can be classified according to location, route of penetration, and severity of the process.

If we talk about the course of the disease, then there is an acute or chronic type.

If we are talking about how the bone tissue became infected, then it is worth noting three types of osteomyelitis - post-traumatic, hematogenous, odontogenic.

If we take into account the localization of the purulent process, then it is worth distinguishing between the disease of the lower jaw and the upper jaw.

Treatment of acute odontogenic osteomyelitis of the jaw

Treatment of acute odontogenic osteomyelitis of the jaw is carried out comprehensively - conservatively and surgically.

Surgical procedures play the main role. At the time of the patient’s treatment, the source of infection in the oral cavity – the tooth – must be removed. Primary surgical treatment of the inflamed area is also performed. The drainage of purulent exudate is ensured by periostotomy and drainage. Next, the patient undergoes observation by a maxillofacial surgeon, comes for dressings, and follows the doctor’s recommendations.

They are followed by conservative treatment:

Antibiotics taking into account the cultures performed + preference for those tropic to bone tissue (lincomycin, clindamycin, doxycycline),
Antihistamines,
Analgesics, antipyretics,
Detoxification therapy,
Rest, bed rest,
Individually selected exercise therapy exercises, physiotherapy.

Acute hematogenous osteomyelitis of the jaw

Acute hematogenous osteomyelitis of the jaw develops when the bone marrow is damaged by an infection introduced into the bone through vessels from the primary focus located outside the maxillofacial area.

Microorganisms can also enter the jaw by contact from inflammatory foci on the skin of the face (boils, erysipelas).

The difficulty of timely diagnosis leads to the transition of the acute stage of the disease to the chronic stage.

Treatment will be carried out in the same way as for odontogenic osteomyelitis, only the removal of the primary lesion is carried out by a general surgeon.

Acute osteomyelitis in children

This form of the disease is most often observed in children. Here the clinical picture has pronounced symptoms that are characteristic of general intoxication. Inflammation and destruction also develop. This happens not only in the bone, but also in those soft tissues that are around.

Osteomyelitis in children often occurs as a result of certain characteristics of the body (functional, anatomical):

there is hypersensitivity to infections, a high rate of reactivity;
bone tissue is actively growing;
when baby teeth erupt or change, the jaw structures are rebuilt;
The Haversian canals are wider, and the bone trabeculae are quite thin;
abundant network of blood vessels.

Classification of pathology

Depending on the method of infection, the following types are distinguished:

Hematogenous - bacteria spread through the circulatory system from other infectious foci. This path is typical for secondary osteomyelitis of the upper jaw, which develops against the background of another disease. This could be scarlet fever, purulent otitis media, tonsillitis, or diseases of the larynx. First, the infection affects the bone tissue of the jaw, and then only the teeth and gums.

Odontogenic – external route of infection. The cause is an infected pulp or tooth root. Predisposing factors include advanced dental diseases. These are pulpitis, periodontitis, the presence of cystic formations, alveolitis.
Traumatic – fractures and injuries of the jaw joint with damage to soft tissues and the presence of fragments of the dentition. Often occurs due to late seeking medical help.

According to the course and nature of the manifestation of symptoms, the pathology can be acute, subacute and chronic. Based on the area of distribution, local (limited) and diffuse (diffuse) forms are distinguished.

Causes

Acute odontogenic osteomyelitis occurs from teeth that have been affected by caries or from pathogenic microorganisms that have penetrated. Typically, a similar form is diagnosed on the lower jaw. At the same time, the age period of children is 7-12 years;
acute hematogenous osteomyelitis is the result of an infection that appeared from other foci. For example, it could be omphalitis (when the umbilical ring becomes inflamed), purulent mastitis, which the baby’s mother suffers from. If we talk about older children, they can become infected as a result of skin infections, tonsillitis, and purulent otitis media. This form occurs in the upper jaw and is accompanied by infection of the internal organs;
Acute traumatic osteomyelitis is rarely diagnosed. It can be caused by infection of the line where the jaw fracture is noted. This occurs in case of injury, also after operations in this area. Often this disease occurs if the bone fragments are not properly treated, if bone fragments are immobilized, and also if carious teeth are caught in the fracture line and the skin and oral mucous membranes are damaged.

Treatment of osteomyelitis in a child

The term “osteomyelitis” is an inflammation caused by an infection that begins with the purulent-necrotic development of the disease. This disease develops in the bone marrow and surrounding soft tissues.

This disease in children is considered the most dangerous, because the disease affects the bone marrow and is almost invisible outwardly. In most cases, the disease occurs more often in boys due to a more active lifestyle (fights, injuries, dislocation in a child

etc.).

The main causes of osteomyelitis may be:

Falls and injuries;
Purulent infections;
Staphylococcus aureus;
Fractures;
Pyelonephritis;
Burns;
Otitis.

Osteomyelitis mainly occurs due to severe intoxication of the body. The dangerous thing is that initially with a chronic disease there are no clear symptoms, mainly minor pains arise that do not have an exact location.

In the secondary case of a chronic disease, more visible symptoms occur, for example, pain when touching something, fever, and pus is released in the fistulas. In this case, the disease affects the liver, heart and kidneys.

This disease is difficult to diagnose at an early stage (which is very important); if treatment is not started on time, the skeleton of children is deformed, which can cause problems with the spine

, severe consequences or disability.

How to recognize the disease in children?

The main signs may be:

Arthritis of the extremities;
Chills;
Swelling;
Redness;
Drowsiness and apathy;
Rapid pulse;
Increased bone pain.

Osteomyelitis in children of different ages manifests itself differently, for example, newborns will be characterized by lethargy, fever, vomiting, irritability and lack of appetite.

Older children have the same symptoms only more pronounced, inflammation develops longer and symptoms in the form of swelling and redness can be observed after a week after the onset of the disease.

The fundamental sign of the disease in children of different ages is an increase in bone pain, which can be noticed by observing a child who tries not to move this limb or touches various objects.

There are 2 forms of osteomyelitis:

The first form (specific) occurs as a secondary disease, which is caused by infections, for example, tuberculosis, syphilis and brucellosis.
The second form (nonspecific) occurs due to the formation of purulent cocci and microbes.

The first form of osteomyelitis is rare, but no less dangerous.

Types of osteomyelitis in a child:

The first type is odontogenic. This type occurs in the form of inflammation of the jaw bones due to dental diseases. Inflammation quickly spreads throughout the jaw area, because... the jaw is filled with many blood vessels. This disease most often occurs in children 7-12 years old.
The second type is hematogenous osteomyelitis. This inflammation occurs due to microorganisms that penetrate the connecting bone tissue through the bloodstream. This type of osteomyelitis is divided into acute and chronic. The chronic form lasts about 4 months and is divided into 2 subtypes, primary and secondary. The first form is dangerous because it does not show any symptoms, and secondary osteomyelitis is a consequence of the acute hematogenous form.
The third type (exogenous or post-traumatic), occurs when receiving injuries, fractures, gunshot wounds, inflammation of bone tissue.
The last and no less important type is contact. This type is one of the varieties of exogenous osteomyelitis, which occurs if purulent inflammation moves from soft tissue to bone.

How is osteomyelitis diagnosed?

Diagnosing the disease is a very difficult procedure, because... it is very easy to confuse it with diseases such as rheumatism, purulent arthritis, Ewing's sarcoma. The difficulty in confusing these diseases is that osteomyelitis has very similar symptoms to other diseases.

Treatment methods for osteomyelitis in children are:

Immunotherapy;
Introduction of vaccines and bacteriophage so that the allergen loses its reaction;
Pressure on the bone marrow and its components is eliminated;
Vitamin therapy;
Surgical intervention;
Drainage is installed to drain purulent manifestations.

Basic treatment methods

Initial treatment in children begins with a course of antibiotics, which is very important in the early stages of the disease; the course of treatment lasts from 1 to 3 months. Treatment with antibiotics is necessary to stop the inflammatory process.

A secondary treatment is considered to be surgical intervention, when the doctor, opening the abscesses, washes the canals from pus, and also removes the diseased tooth, and the wounds are drained. The operation is performed under local anesthesia and is the main treatment for children.

The disease continues to be treated even after the main treatment process, massage, physical therapy, balneotherapy and much more are performed.

Children need to undergo treatment in a hospital about twice a year, this is necessary so that the child receives vitamin, laser and magnetotherapy during the period of treatment. In sanatoriums, immunomodulators are used and children undergo a course of antibiotics, and X-rays are also taken to monitor the disease.

Prevention of this disease will include: proper nutrition, a healthy lifestyle and medical examinations at some intervals.

If you feel unwell, you should immediately consult a doctor for a quick diagnosis.
Do not be negligent about the health of your loved ones. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Symptoms

Acute osteomyelitis appears very suddenly. If children are small, then they are noted to be moody and lethargic. They don’t want to eat, they don’t sleep well, and their temperature rises. If the child is older, then he may feel unwell, general weakness, and may complain of toothache.

When the disease is still in its early stages, the following manifestations may be present:

bone pain. Initially it has a local character, and then diffused;
the oral mucosa swells, hyperemia is noted;
on the side that is affected, the soft tissues become swollen;
the face becomes asymmetrical;
chewing muscles may spasm.

If an injury occurs, signs of the disease appear after 3-5 days. The child feels much worse, the temperature rises, and pus may also be released if the mucous membrane has been damaged.

Diagnostics

It is based on X-ray examination. When the disease is just beginning, the images may show symptoms of osteoporosis (in the area where the inflammatory process occurs). And after a few days, radiographs already show foci of destruction. After another 2-3 weeks, bone necrosis is already visible, as well as the places where sequestra have formed.

Treatment

Here it is necessary to carry out certain measures that will help eliminate foci of inflammation and restore those functions that have been impaired.

Every case of childhood osteomyelitis must be treated urgently. To do this, you should call a doctor and admit the child to the hospital. If surgical intervention is performed on time, then we can talk about a positive prognosis and outcome.

In the case of odontogenic osteomyelitis, the tooth that provoked the inflammatory process should be quickly removed. When it comes to children, teeth can be removed, both baby and permanent teeth. After tooth extraction. the hole acts as natural drainage. However, sometimes the bone marrow spaces are opened to improve the drainage of pus.

After the tooth has been removed, the subperiosteal abscesses are opened or a periostotomy is performed.

During sanitation, they not only open, but also thoroughly clean the destruction cavity and remove necrotic masses from there. Antibiotics and antiseptics are used for washing, and drainage is also done. As for conservative therapy, special drugs from the groups of immunostimulants, anti-inflammatory and antibacterial are used.

Causes of osteomyelitis

Penetration of bacteria into bone, which traditionally occurs as follows:

against the background of tooth damage by caries, that is, by odontogenic means. First, microorganisms penetrate the pulp, after which they enter the hard tissue through the lymph nodes or canals;
after fur. tooth damage: dislocations, fractures, operations, etc.
due to the penetration of infection during ENT diseases, skin inflammation, when microorganisms from one source of inflammation pass into the bone.

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 upper jaw: symptoms and diagnosis

The disease develops slowly. The first symptom of a sluggish chronic inflammatory process is pain in the area of the damaged tooth.

The following manifestations are added:

as the infection spreads, the pain intensifies and covers the area of several teeth or the entire jaw;
swelling and redness of the gums;
tooth mobility;
local pain in the temple area, in the ear;
numbness of the chin;
difficulty swallowing and chewing;
speech disturbances due to numbness or burning of the jaw;
putrid odor from the mouth;
enlarged lymph nodes as a reaction to severe inflammation;
change in the shape of the face (swelling due to the pathological process).

Symptoms arise gradually in a chronic course.

Acute osteomyelitis of the lower jaw develops sharply. Accompanied by high body temperature and chills. If the outflow of purulent contents is disrupted, then purulent abscesses are formed, and the formation of perimaxillary phlegmon is possible. Such formations are dangerous and require surgical intervention. This dental pathology is often confused with another acute infectious disease - mumps (mumps).

Important! If your health suddenly deteriorates, you must call an ambulance.

On average, the acute period lasts 7–14 days. Then the symptoms subside and the subacute period begins. It occurs after the formation of a fistula to release pus from the source of infection. During this phase, the general condition improves, the pain becomes tolerable. But tooth mobility not only remains, but also gets worse. This leads to problems with chewing food and becomes a risk factor for the development of gastrointestinal diseases.

The subacute form often becomes chronic with a sluggish course that can last several months. The outcome is the rejection of all necrotic areas of bone tissue with the formation of sequesters (fragments of dead tissue). They are removed through the resulting fistula. This is a favorable outcome, which still requires examination and treatment by a specialist. However, the outflow of purulent contents is often difficult, which leads to damage to soft tissues, deformation of the jaw and the spread of the purulent process.

Which doctor should I contact: diagnosis of the disease

If you experience toothache of an unclear nature, as well as pathological changes in periodontal tissue, you should contact a dentist.

If necessary, he will refer you to a specialist - an orthodontist, surgeon or orthopedist.

The initial stage of the pathology may not yet be visualized using x-ray diagnostic methods. Therefore, collection and study of anamnesis and external examination are used.

The doctor pays attention to the following points:

Degree of tooth mobility.
Condition of the oral mucosa and gums.
The presence of a painful syndrome when tapping.

Since osteomyelitis is a purulent infectious process that affects many processes in the body, it is advisable to prescribe laboratory general blood and urine tests. Also, to accurately determine the type of pathogenic pathogen, bacterial culture of the purulent contents is carried out.

In advanced forms of the disease (chronic or subacute stage), changes in bone tissue are already significant and noticeable, so an X-ray or computed tomography of the jaw is recommended. Such methods help to see the formed areas of dead tissue (sequestra), as well as to understand how deeply the inflammatory process has spread.

If there is a fistula tract with purulent contents, biomaterial is taken for laboratory testing. This is necessary to exclude actinomycosis of the maxillofacial area.

Important! The acute form of osteomyelitis must be differentiated from similar pathologies: purulent periostitis, festering cyst, acute periodontitis. Therefore, the experience and professionalism of the doctor is important here.

Primary chronic

It's rare to see a form like this. Typically, this disease is caused by weakly active microorganisms. They penetrate from teeth affected by caries. They are the ones who maintain inflammation for a long time.

This form of osteomyelitis is characterized by a productive nature, since the processes of destruction observed in bone tissue are weakly expressed. However, during this process new bone is actively formed.

If we study the clinical picture of primary chronic osteomyelitis, then the acute period is omitted. The child's condition generally remains the same, only fatigue, pale skin, and weakness appear. As for local signs, the area of the causative tooth hurts a little, the jaw bones and their thickness increase, and also symptoms of lymphadenitis appear in the lymph nodes. There are no fistulas on the skin or mucous membranes.

At an early stage, the productive form of the disease can be easily treated with conservative methods. If you choose the right means, you can achieve positive results quite quickly and without consequences. If the case is advanced, then surgical intervention will be required. It is used to remove too much bone tissue, as well as dead tooth germs. After that, they model the correct jaw contour.

Diagnosis of osteomyelitis

It is carried out exclusively by a dentist, based on clinical and laboratory studies. Differential diagnosis is also involved.

Basic methods for diagnosing pathology:

general and biochemical blood tests;
general urine analysis;
X-ray of the jaw;
MRI of the jaw;
bacteriological examination of purulent contents of fistulas;
research for diseases that led to bone destruction.

Consequences and rehabilitation

Osteomyelitis can have quite serious consequences in childhood:

defects associated with bone tissue;
jaw fractures that cause abnormal joints to form;
the jaw is deformed;
absence of permanent teeth, edentia;
arthrosis, ankylosis, arthritis that relate to the joints of the temples and lower jaw;
the jaw grows much more slowly, microgeny is noted;
soft tissues are deformed and look like scars.

Due to the above complications, cosmetic defects may occur, but they do not have any effect on the masticatory apparatus or its functioning.

In order to restore the anatomy of the face and jaw to the maximum and ensure its normal functioning, it is necessary to take certain rehabilitation measures:

sometimes plastic surgery is used. But this is done only after the facial bone stops growing;
If adentia develops, then temporary dental prosthetics can be done. And as soon as the skeleton is finally formed, then permanent prosthetics are allowed;
To improve the temporomandibular joint and its functioning, it is worth applying physiotherapeutic procedures.

All children who have suffered osteomyelitis that affected the jaw area are registered at the dispensary. They are required to visit the dentist at least 2 times a year.