OSTEOMYELITIS

an acute or chronic inflammatory process in the medullary spaces or cortical surfaces of bone ………………..the initial site of involvementmost often from a…………..

periapical abscess.

The second most common cause…..

Physical injury

Most cases are……………………… infectious

.1Acute osteomyelitis

when an acute inflammatory process spreads through the medullary spaces of the bone

2.Chronic osteomyelitis

the defensive response leads to the production of granulation tissue…….an attempt to wall off the infected area.

all ages.a strong male predominance.Most cases involve the mandible

1.More diffuse blood supply 2.The grater proportion of cancellous bone

.………In maxilla

Acute osteomyelitis.

signs and symptoms of an acute inflammatory process that has typically been less than1 month in duration. FeverleukocytosisLymphadenopathysignificant sensitivity soft-tissue swelling

an ill-defined radiolucency

Usually,no radiographic evidence

Unless

approximately 60 %Demineralizationof the bone

On occasion…………paresthesia of the lower lipdrainageexfoliation of fragments of necrotic bone (sequestrum).

Involucrumthe mass of encased nonvital bone that may become surrounded by vital bone,

central radiopaque mass ofnecrotic bone.

Chronic osteomyelits

If acute osteomyelitis is not resolved or primarily without a previous acute episode.

SwellingPainsinus formation purulent discharge,sequestrum formationtooth losspathologic fracture.

a patchy, ragged, and ill-defined radiolucencyoften contains ……..central radiopaque sequestra.

Histopathologic FeaturesGeneration of biopsy is not common ….. predominantly liquid content and lack of a soft-tissue component. When submitted, the material consists …………….necrotic bone. a loss of the osteocytes from their lacunae

acute osteomyelitis

Normal woven bone

bacterial colonization

Necrotic debries

acute inflammatory infiltrate consisting of PMNs.

Chronic osteomyelitisa significant soft-tissue component that consists of chronically or subacutely inflamed fibrous connective tissue filling the intertrabecular areas of the bone.

irregular fragment of devitalized bone surrounded by dense fibrous tissue heavily infiltrated by plasma cells, lymphocytes, and only a few granulocytes

Acute osteomyelitis…… 1.antibiotics 2. drainage.

Treatment and Prognosis

1.similar antibiotics ……..but intravenously in high doses.

Chronic osteomyelitis.

2.Surgical removal of all infected material surgical down………….. to good bleeding bone .