Dr Peter Julius Ngala, DDS

The word osteomyelitis originates from the ancient Greek words osteon (bone) and muelinos (marrow) and literally means the infection of the medullary portion of the bone.

Definition: It is an acute or chronic inflammatory process in the medullary spaces or cortical surfaces of the bone that extends away from the initial site of involvement.

A). According to anatomic location of infectious process

Intramedullary

Subperiosteal

Periosteal

B). According to duration and severity

Acute

Subacute

Chronic

C). Depending upon the presence or absence of pus

Suppurative osteomyelitis (acute and chronic)

Non suppurative osteomyelitis eg. Chronic diffuse sclerosing osteomyelitis, chronic focal sclerosing osteomyelitis (condensing osteitis), garre’s osteomyelitis and osteoradionecrosis

Fracture due to trauma from road traffic accidents

Gunshot wounds

Radiation damage

Pagets disease

Osteopetrosis

Systemic conditions like leukemia, sickle cell anemia and uncontrolled diabetes mellitus.

Acute inflammation (edema, pus formation)

Increased intramedullary pressure

Vascular collapse (stasis, thrombosis, ischemia of bone)

Compromised local blood supply of the bone in the harvesian canals.

Avascular bone

Sequestrum formation

It is more common in men than in women.

May involve either maxilla or the mandible.

RARE in occurrence as compared to the mandible due to

Extensive blood supply and significant collaterals

Porous nature of the membranous bones

Thin cortical plates

Abundant medullary spaces

An important factor in establishment of osteomyelitis in mandible is compromise of blood supply.

Blood supply of the mandible?

Primary blood supply is by the inferior alveolar artery

Secondary supply is by periosteal blood vessels

It is due to this lack of collateral circulation and dense nature of mandible that makes it prone to osteomyelitis than any other bone in the facial region.

Severe pain

Paresthesia or anesthesia of the mental nerve

Anorexia

Malaise

Fever

Regional lymphadenopathy

Fetid oral odor

Pus exudates around the gingival sulcus

Cutaneous fistula

Usually painless unless there is an acute or sub acute exacerbation.

Gradual development of sequestra without fistula. The sinus develops intermittently and drains small amount of pus and then gradually heals.

Necrotic bone in some cases may be visible inside the oral cavity.

Clinical diagnosis through history of the patient

Radiological diagnosis (loss of lamina dura, sequestrum formation and moth eaten appearance)

Laboratory diagnosis (medullary spaces are filled with inflammatory exudates that may progress to the actual formation of pus)

Pagets disease

Eosinophilic granuloma

Incision and drainage (where there is evidence of pus)

Irrigation and debridement of necrotic areas

Empiric antibiotic therapy

Sequestrectomy

Saucerization

Decortication

Hyperbaric oxygen therapy