DISEASE OF THE JAWS : JAW OSTEOMYELITIS (OSTEOMYELITIS MAXILLAE MANDIBULAE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. By origin distinguish osteomyelitis:
Infectious Lodicules odontogenic osteomyelitis is usually a mixed group of microbes: Staphylococcus, Streptococcus, anaerobes. Traumatic osteomyelitis in most cases are infectious, as was usually accompanied by open fractures of the jaws. Hematogenous osteomyelitis occur as the most common complication of infection (fever, influenza, scarlet fever), however, the causative agent of osteomyelitis is not always the microbe that caused General disease.
The pathogenesis. The development of odontogenic osteomyelitis should be considered as a complication of periodontitis in connection with the activation and exacerbation of infectious-inflammatory process in the periodontal tissues of the slit. When acute odontogenic osteomyelitis infection is molded from periodontal disease in bone marrow cells of the alveolar process and body of the jaw by lymphatic and haversian systems, elements of which pierce together with blood vessels and nerves of the walls and bottom of the alveoli and directly linked periodontal slit with cerebral part of the bone. Further development of infectious-inflammatory process is in the form of, or limited, or diffuse osteomyelitis.
Symptoms are different depending on the stage of the disease, which is infection and inflammation can be divided into three clinical stages:
The phenomenon of diffuse acute or sub-acute periodontitis; in jaw, pain of acute, spontaneous, often radiating, long-lasting, resistant, functional lockjaw, inflammatory infiltration of the bone and adjacent soft tissue: diffuse peristaltichesky pain; altered sensitivity of the skin: fever, high or low-grade fever. In colocolostomy tissue phenomena phlegmonous inflammation; palpable infiltration, the skin is tense, is not going to fold; localization is more frequent in the submandibular triangle, and sometimes the chin or the parotid region. The phenomenon of diffuse cellulitis, exciting several areas - submandibular triangle and floor of the mouth (sore throat Louis), difficulty swallowing, septic phenomena. Subacute and chronic osteomyelitis can detect the destruction of bone tissue by x-ray studies.
Course and complications. The course of acute osteomyelitis is different, sometimes the predominant lesion of the bone, sometimes the disease is determined mainly by inflammation colocolostomy fiber. In the future, with the defeat of the bones develop necrosis of individual sections, are formed sequesters. In some cases, especially with timely dissection subperiosteal abscess, the process in the bones permitted without sequestration. For cellulitis is determined by the increase in inflammatory infiltration with subsequent purulent melting. Complication of osteomyelitis in the acute period is the development of diffuse cellulitis of the nature of angina Louis. In addition, sometimes, especially in the upper jaw, the possible complications phlebitis in the system of branches of the facial vein and the pterygoid plexus. Under sequestration for osteomyelitis may be complicated by pathologic fracture.
Recognition presents some difficulties, mainly in the early acute stage, when you have to differentsirovat with severe periodontitis. The difference in acute periodontitis morbid manifestations are concentrated in the area of the affected tooth, for acute osteomyelitis - diffuse multiple periodontitis, chills, fever.
The disease should be considered as a severe suffering with a poor prognosis.
Only in the initial stages of the disease is sometimes possible to arrest the process, applying dry heat, blue light, Solux erythema dose of ultraviolet rays. In all cases it is recommended to start treatment with incision of the periosteum in the area of the transition folds, and other methods are used as an additional intervention. If these measures prove insufficient, it is necessary to produce extraoral incision under the lower edge of the jaw. In almost all cases of acute osteomyelitis of the jaw is necessary to apply a common therapy: calcium in the form of drip enemas 300 - 500 ml of a 2% solution one or two times a day. Streptocide. In severe cases, penicillin 50 000 units, 3 hours, intravenous injection of 2 - 5% solution of calcium chloride in the amount of 5,0 - 10,0 - 20,0. Chronic osteomyelitis require necrotomy, tooth extractions, which served as the beginning of the disease. Indications for sequestrotomy installed only with complete separation of the dead portion of bone. In some cases, when the threat of fracture or arising pathological process is appropriate to use the stimulatory action of sequestration for enhanced osteogenesis. In cases of violation of the integrity of the lower jaw or for the prevention of fracture are different fixing tires, inclined plane, maxillary elastic traction.