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

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

3. 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.

4. TYPES OF OSTEOMYELITIS
ACUTE OSTEOMYELITIS
CHRONIC OSTEOMYELITIS
GARRE OSTEOMYELITIS

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

6. 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)

7. 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

8. 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)

9. 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

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

11. 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

12. 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

13. 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

14. THANK YOU
FOR YOUR ATTENTION