Osteomyelitis is called inflammation of bone tissue and bone marrow. One third of all diseases in this group refers to osteomyelitis of the jaw. In this case, the lower jaw is affected twice as often. The disease can occur in acute, subacute and chronic forms. According to the source of infection, odontogenic, traumatic, hematogenous and specific types are distinguished. In addition, osteomyelitis is limited and diffuse (diffuse); light, medium and heavy; with and without complications.
Causes of osteomyelitis of the jaw
The disease develops as a result of infection in the bone tissue. As a rule, the causative agent is Staphylococcus aureus, as well as other cocci, rod-shaped bacteria, rarely viruses.
Most often in medical practice there is odontogenic osteomyelitis, in which the infection enters the bone from the pulp of a diseased tooth through the lymphatic vessels or bone tubules. In 70% of cases, this occurs through the large molars of the lower teeth.
Traumatic osteomyelitis of the jaw can develop when the jaw is fractured as a result of microorganisms entering the wound. Its prevalence is less than 25%from all cases.
Hematogenous osteomyelitis is the least diagnosed, which occurs when the infection is transferred from the foci of inflammation to the bone tissue with blood. This can happen with chronic tonsillitis, as well as acute processes such as scarlet fever, diphtheria and others. In this case, the bone is first affected, and then the teeth.
Osteomyelitis of the jaw. Symptoms
In the case of an acute process, an increased body temperature is observed. Patients complain of general malaise, pain, swelling, redness of the mucosa in the area of the causative tooth, mobility of neighboring ones. There is a decrease in jaw mobility, the development of an abscess, an increase and soreness of the cervical lymph nodes.
With relief after the release of pus, a subacute form occurs. The inflammation is somewhat dulled, but the decay of bone tissue continues. At this stage, sequesters are formed - areas of necrotic bone. Sequesters can be different in form, multiple and single, small and large. Formed defects or sequestral cavities lined with granulation tissue communicate with the mucous membrane and skin in fistulous tracts.
Chronic osteomyelitis is characterized by a long course - up to several months. The periods of subsidence are replaced by exacerbations with the formation of new fistulas, there is a rejection of dead areas of the bone. Self-healing is rare.
Diagnosis of osteomyelitis of the jaw
Diagnosis is based on examination, patient complaints,X-ray examination, blood test. Differential diagnosis is carried out with acute purulent periostitis and tumors.
Complications of osteomyelitis of the jaw
The danger of the disease lies in the fact that severe complications are not excluded, such as abscess, phlegmon, phlebitis of the facial veins, sepsis.
Treatment and prevention
Treatment consists primarily in the removal of a diseased tooth. In addition, an incision is made in the periosteum for the outflow of exudate - a fluid that is formed during the inflammatory process. The bone is washed with antiseptics, anti-inflammatory, detoxification and symptomatic treatment is prescribed. Physiotherapy is indicated: electrophoresis, UHF, ultrasound. Often it is necessary to resort to surgical intervention to remove dead areas of the bone. Small sequesters can resolve on their own. After their discharge or surgical removal, the cavity is filled with connective, and then bone tissue, and scarring of the fistulous passages occurs.
Prevention of osteomyelitis of the jaw comes down to the timely treatment of caries, jaw injuries, acute and chronic infections of the upper respiratory tract.
