DISORDERS OF MAXILLA AND MANDIBLE DNT 243 DR.SHAHZADI TAYYABA HASHMI DISORDERS OF MAXILLA AND MANDIBLE

DISORDERS OF MAXILLA AND MANDIBLE MAJOR INFECTIONS OF JAWS CYSTS OF JAWS ODONTOGENIC and NON-ODONTOGENIC TUMOURS OF JAWS

MAJOR INFECTIONS OF JAWS OSTEOMYELITIS Definition: An inflammatory process within medullary ( trabecular) bone that involves the marrow spaces Osteomyelitis of jaws is mainly a disease of adults with several potential sources of infection.

TYPES OF OSTEOMYELITIS ACUTE OSTEOMYELITIS CHRONIC OSTEOMYELITIS GARRE OSTEOMYELITIS

ACUTE OSTEOMYELITIS DEFINITION A rapidly destructive inflammatory process within bone that consist of Granulation tissue, Purulent exudate and islands of non-vital bone (sequestra)

CAUSES OF ACUTE OSTEOMYELITIS Caused by direct extension of untreated periapical abcess Minor traumatic incident involving a mandible that has its blood supply compromised by previous high doses of radiation for the treatment of malignancy( OSTEORADIONECROSIS)

CLINICAL FEATURES OF ACUTE OSTEOMYELITIS Commonly affects males with infection of mandible Early complaints are Severe, Throbbing pain and swelling with external swelling due to inflammatory edema Later distension of periosteum with pus occurs Finally, subperiosteal bone formation causes the swelling to become firm Associated teeth are tender and mobile Overlying gingiva is red, swollen and tender Paresthesia of lower lip of affected side Regional lymph nodes are enlarged and tender Difficulty in mouth opening and swallowing

Thrombosis and obstruction leads to future bone necrosis PATHOLOGY Oral bacteria particularly anaerobes such as BACTEROIDES, PORPHROMONAS or PREVOTELLA species are important causes Staphylococci may also cause infection when they enter from the skin through open fracture Mandible has a relatively limited blood supply and dense bone with thick cortical plate (so pus cant drain out) Infection causes acute inflammation in the MEDULLARY soft tissues and inflammation EXUDATE spreads infection through marrow spaces . It also compress blood vessels Thrombosis and obstruction leads to future bone necrosis Dead bone is recognized microscopically by lacunae, empty of OSTEOCYTES but filled with NEUTROPHILS and colonies of bacteria which proliferate in the dead tissue Pus formed by inflammatory cells, reaches the SUBPERIOSTEAL region by RESORPTION of bone At boundaries between infected and healthy tissues, OSTEOCLASTS RESORBS the periphery of dead bone and become separated as SEQUESTRUM( island of dead bone)

RADIOGRAPHIC FEATURES OF OSTEOMYELITIS Loss of trabecular pattern and areas of radiolucency indicates bone destruction Ill-defined margins with fluffy and moth-eaten appearance Areas of dead bone appears as dense areas TREATMENT: Surgical treatment to establish drainage of purulent exudates Use of antibiotics to kill the microorganisms involved

RADIOGRAPHIC FEATURES AND TREATMENT Radiographic features are variable but sometimes distinctive Sequestra will usually separate spontaneously TREATMENT: Antibiotics

CHRONIC OSTEOMYELITIS Persistent low grade infection associated with bone destruction and Granulation tissue formation with little suppuration CLINICAL FEATURES: Persistent ache / pain with exposed bone

GARRE OSTEOMYELITIS It is an unusual hyperplasic reaction of the periosteum to a chronic osteomyelitis of the posterior mandible that is unique to young patients. CLINICAL FEATURES: Most frequently associated with advanced acute caries in young patients Occurs when free gingival margin remain above the height of contour of tooth results in food impaction

RADIOGRAPHIC APPEARANCE AND TREATMENT onion skin appearance TREATMENT: Identification of source of infection Extraction of the tooth involved in infection Surgical treatment of tissues in molar area

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