Jaw osteomyelitis. Osteomyelitis of the jaw - causes, methods of diagnosis and treatment

Osteomyelitis of the jaw is an infectious purulent-necrotic process that develops in the bone and bone marrow of the jaw, as well as in the surrounding soft tissues, against the background of preliminary sensitization of the body. Let's analyze each point of the definition.

Process infectious, is caused by mixed microflora, mainly golden and white staphylococci, as well as streptococci, pneumococci, Escherichia coli and typhoid bacilli. By the way, osteomyelitis of other bones of the human skeleton is caused by a single pathogen, which is introduced into the bone through the hematogenous route. Most often these are staphylococci or streptococci. That's why osteomyelitis of the jaw has its own distinctive features in the course and clinical picture associated with the variety of pathogens.

Inflammation of the bone marrow resolves with the formation pus And necrosis bone tissue.

In addition to damage to the bone itself, the adjacent soft fabrics, such as gums, oral mucosa, masticatory and facial muscles, salivary glands, facial skin. In severe cases, phlegmon and abscesses of the soft tissues of the face develop. Thus, the clinical picture of soft tissue damage is also added to the painful course of osteomyelitis.

Plays a major role in the development of osteomyelitis general health of the person. Not every periodontitis or periostitis turns into osteomyelitis. Weakening the body's defenses increases the risk of developing osteomyelitis.

Osteomyelitis of the jaw is more common than damage to other bones of the human skeleton. This is due to the presence several factors which can lead to inflammation of the alveolar process of the upper and body and lower jaw:

1. Teeth. With complications of caries, namely acute chronic apical periodontitis, the infection through the tooth canal enters further into the bone space and over time leads to inflammation of the bone marrow. And since there are several teeth, the role of this factor increases in proportion to their number.
2. good blood supply maxillofacial region. For example, in the body and alveolar process of the upper jaw there are a large number of vessels and their anastomoses, which increases the risk of hematogenous infection into the jaw.
3. Cavities. Near the dental system there are cavities (maxillary sinus, oral cavity, nasal cavity), from which infectious agents can enter the bone substance and cause further complications. The cavities themselves are delimited from the bone by a thin layer of soft tissue, which does not greatly prevent the further spread of infection from the cavity to the jaw.
4. Injuries. The face is often exposed to various types of injuries: domestic and sports injuries, jaw fractures, bruises. In case of jaw fractures, untimely and inadequately provided assistance can lead to infection in the wound and further development of inflammation or to non-union of fragments and the occurrence of traumatic osteomyelitis.

Classification of osteomyelitis of the jaws

Classification of osteomyelitis of the jaws:

1. By etiology:
   • Infectious
     • Odontogenic;
     • Non-odontogenic.
   • Non-infectious:
     • Traumatic;

1. Downstream:
   • Spicy;
   • Chronic;
   • Exacerbation of chronic.
2. By localization:
   • Upper jaw;
   • Lower jaw.
3. By prevalence:
   • Limited;
   • Diffuse.

Acute osteomyelitis of the jaw

Acute osteomyelitis of the jaw, as indicated in the classification, can be infectious (odontogenic and non-odontogenic) and non-infectious in origin - traumatic.

Let's consider the most common acute osteomyelitis of the jaw - odontogenic.

Acute odontogenic osteomyelitis of the jaw

Acute odontogenic osteomyelitis develops as a complication of chronic apical periodontitis (during an exacerbation) or acute purulent periostitis.

Acute odontogenic osteomyelitis: symptoms

Symptoms of acute odontogenic osteomyelitis are divided into general and local.

General symptoms are associated with severe intoxication of the body. The patient's temperature is elevated to 39-40°C; during the day the temperature can change by 2-3 degrees. The patient complains of headache, weakness, loss of appetite. In severe cases of osteomyelitis, the patient may complain of nausea, vomiting, and constipation.

• Facial asymmetry caused by soft tissue swelling
• Pallor of the skin,
• Regional lymph nodes are inflamed on the affected side, painful on palpation,
• Difficulty opening the mouth, swallowing saliva and food,
• Coated tongue, bad breath,
• Mobility of several teeth
• Pain when percussing the causative tooth and nearby intact teeth,
• The gums are swollen and hyperemic on both sides (vestibular and oral),
• Often complicated by abscesses and phlegmon of nearby soft tissues.

Diagnosis of osteomyelitis of the jaw

Diagnosis of osteomyelitis of the jaw is carried out comprehensively, based on clinical and laboratory tests. It is also worth paying attention to differential diagnosis.

Clinical studies are carried out by a dentist during examination; they identify the general and local symptoms of the disease mentioned above.

Laboratory research:

1. Changes in blood:

• ESR increased to 40-70 mm/h,
• Leukocytosis, shift of the leukocyte formula to the left (with leukopenia the prognosis is unfavorable, the immune system cannot cope with inflammation on its own),
• Positive test for C-reactive protein,
• Decrease in the amount of albumin, increase in globulin content,
• Alkaline and acid phosphatase activity levels increase in proportion to the severity of the disease.

2.Changes in urine:

• The appearance of protein, blood cells,
• Hyaline and granular casts.

On the radiograph there are no changes in the bone, except for the already existing inflammatory processes near the apex of the root or several roots of the causative tooth in the first week of the disease. Most often - “tongues of flame” of chronic granulating periodontitis. By the end of the second week, the bone becomes more transparent due to destruction processes.

Differential diagnosis is carried out with other types of osteomyelitis (hematogenous, traumatic), acute periostitis, benign and malignant neoplasms, damage to oral tissues by specific infectious diseases: tuberculosis, syphilis, actinomycosis.

Acute odontogenic osteomyelitis of the lower jaw

Acute odontogenic osteomyelitis of the lower jaw occurs more often than lesions of the upper jaw, which is due to the peculiarities of its anatomical structure.

More often, the causative teeth are molars and premolars, and in this case the disease is diffuse in nature. With periodontitis of the incisors, limited osteomyelitis may develop.

Bone destruction occurs on a large scale, which often leads to pathological fractures of the jaw.

In addition to damage to the alveolar part of the mandible and its body, the branch and processes of the mandible may be susceptible to inflammation. The purulent-necrotic process in these jaw structures is characterized by an unfavorable prognosis, expressed by general symptoms of the disease.

Another feature is frequent complications from the soft tissues surrounding the lower jaw. This is explained by the large number of muscles directly adjacent to the bone and the presence of numerous cellular spaces.

Acute odontogenic osteomyelitis of the upper jaw

Features of the course of acute odontogenic osteomyelitis of the upper jaw are determined by the anatomical structure of the bone. The disease itself develops less frequently than in the lower jaw. The primary teeth are molars and premolars. Infection from them can also lead to inflammation of the maxillary sinuses. With the development of osteomyelitis from the incisors, inflammatory edema spreads to the upper lip, sometimes to the septum and wings of the nose. If the causative tooth turns out to be a fang, the entire infraorbital area becomes inflamed.

Osteomyelitis of the upper jaw develops faster than that of the lower jaw, is easier, and is less often complicated by phlegmon and soft tissue abscesses. The appearance of fistulas on the skin is uncharacteristic.

All this is due to lower bone density, good vascularization, and the absence of muscles directly adjacent to the bone.

Acute odontogenic osteomyelitis of the maxilla can spread from the alveolar process to the hard palate when the lateral incisors and palatal roots of molars are affected.

Treatment of acute odontogenic osteomyelitis of the jaw

Treatment of acute odontogenic osteomyelitis of the jaw is carried out comprehensively - conservatively and surgically.

Surgical procedures play the main role. When the patient contacts the patient, the source of infection in the oral cavity – the tooth – must be removed. Primary surgical treatment of the inflamed area is also performed. The drainage of purulent exudate is ensured by periostotomy and drainage. Next, the patient undergoes observation by a maxillofacial surgeon, comes for dressings, and follows the doctor’s recommendations.

They are followed by conservative treatment:

• Antibiotics taking into account the cultures performed + preference for those tropic to bone tissue (lincomycin, clindamycin, doxycycline),
• Antihistamines,
• Analgesics, antipyretics,
• Detoxification therapy,
• Rest, bed rest,
• Individually selected exercise therapy exercises, physiotherapy.

Acute hematogenous osteomyelitis of the jaw

Acute hematogenous osteomyelitis of the jaw develops when the bone marrow is damaged by an infection introduced into the bone through vessels from the primary focus located outside the maxillofacial area.

Microorganisms can also enter the jaw by contact from inflammatory foci on the skin of the face (boils, erysipelas).

The difficulty of timely diagnosis leads to the transition of the acute stage of the disease to the chronic stage.

Treatment will be carried out in the same way as for odontogenic osteomyelitis, only the removal of the primary lesion is carried out by a general surgeon.

Acute traumatic osteomyelitis of the jaw

Acute traumatic osteomyelitis of the jaw most often occurs in the lower jaw.

Predisposing factors:

1) Presence of teeth in the bone fracture line,

2) Wound infection (closed fractures are almost never complicated by osteomyelitis),

3) Incorrectly performed immobilization of fragments (late, not long enough, presence of obstacles).

Treatment is re-immobilization of fragments with elimination of the cause of inflammation.

Outcomes and complications of acute osteomyelitis

• Favorable - if the patient contacts a maxillofacial surgeon in a timely manner and receives adequate treatment, the patient’s full recovery is possible.
• Unfavorable – if treatment is insufficient and the patient contacts a doctor late, the following may occur:
• Transition of acute osteomyelitis to chronic,
• Jaw deformity,
• Jaw fracture - occurs with minor physical impact, from which a healthy jaw would not be damaged,
• Complication of osteomyelitis:
  • Abscesses and phlegmons of soft tissues of the face,
  • Thrombosis of facial vessels and cavernous sinus,
  • Mediastinitis,
  • Sepsis,
  • Lethal outcome.

The article was written by Kulba V. Please, when copying material, do not forget to provide a link to the current page.

Osteomyelitis Jaw-Acute Osteomyelitis updated: April 4, 2018 by: Valeria Zelinskaya

Osteomyelitis of the jaw is one of the most severe surgical pathologies. This term refers to an inflammatory process in bone tissue that has a complex course. There are many reasons for its occurrence, some of which remain unconfirmed. An infection that penetrates into bone tissue plays an important role in the formation of the pathological process. The severity of inflammation depends on the state of the immune system.

When bacteria penetrate bone tissue, the human body responds in the form of suppuration. Leukocytes accumulate in the lesion, which are necessary to destroy the foreign agent. They produce a large number of enzymes that destroy tissue and form purulent contents. Bone particles are found in the inflammatory exudate. Often the pathological process involves nearby soft tissues, which contributes to the formation of fistulas.

In a normal state of immunity, inflammation is localized and enters the chronic phase. With immunodeficiency, the infection continues to spread in the body, which is why dangerous consequences such as sepsis develop.

Why does a dental problem occur?

Jaw lesions account for more than 30% of cases of these bone diseases. This is explained by the presence of teeth, which often become sources of infection. In addition, there are a number of conditions that can cause complications. These include:

• the presence of a large number of blood vessels in the facial area;
• rapid bone growth and pronounced changes in their structure during the appearance of molars;
• wide Haversian canals;
• high bone marrow sensitivity.

The entry of any pathogenic microorganism into bone tissue promotes inflammation. The main causes of osteomyelitis of the jaw bone are bacterial infections.

The odontogenic type of this disease is characterized by the presence of carious teeth. Microorganisms live in the pulp, after which they move through the tubules to the bones. Infection in this area can also enter through the hematogenous route. Any source of inflammation that has been present in the body for a long time is dangerous - tonsillitis, boils, erysipelas. Respiratory infections, typhus or mumps can lead to osteomyelitis.

The most rare is the traumatic form of the disease, which occurs against the background of fractures and postoperative complications. Inflammation of the upper jaw develops through the hematogenous route of infection, and in the lower jaw through the odontogenic route. In the first case, the lesion is located in deep tissues, and the symptoms of periostitis will be mild.

Symptoms of the disease

Acute osteomyelitis of the jaw bone occurs spontaneously and has both local and general manifestations. The second ones include:

• febrile syndrome;
• increase in temperature;
• pain in muscles and joints;
• general weakness.

Specific signs are pain in the tooth area, which then spreads throughout the jaw. Inflammation often spreads to the jaw joint, contributing to the development of arthritis. The person becomes unable to completely close their mouth. The tooth that has become the source of infection begins to loosen.

Swelling, which can be seen in the photo, is considered another characteristic sign of acute osteomyelitis. The shape of the face changes, nearby lymph nodes enlarge. The hematogenous form of the disease, which is characterized by damage to the internal organs and bones of the skull, has the most severe course.

Post-traumatic osteomyelitis of the lower jaw in the initial stages occurs in a latent form, which is associated with the presence of symptoms of a fracture. After a few days, the pain intensifies, the patient’s condition worsens, soft tissue swelling occurs and the temperature rises.

Chronic osteomyelitis after tooth extraction does not affect the general well-being of a person. However, it is noted:

• pale skin;
• apathy;
• decreased appetite;
• headaches.

During the examination, fistulas are discovered, which can open both on the face and in the oral cavity. A small amount of pus is released from the passages. Mild swelling of soft tissues and mobility of teeth are noted. During the calm period, the pain is absent and hardly noticeable. The patient cannot always independently determine its location.

Suspicion of osteomyelitis may arise during the initial examination. Further diagnosis involves X-ray examination. There are early and late signs of the disease. The x-ray shows areas of tissue with reduced density, alternating with areas of darkening. The bone pattern appears blurred. The thickness of the periosteum increases due to periostitis.

Osteomyelitis of the tooth socket on days 7–12 leads to the formation of voids and the formation of foci of destruction. In difficult cases, an MRI is performed, which allows us to determine the severity of the disease and the volume of affected tissue.

The activity of infection is assessed using general and biochemical blood tests. Sowing the exudate on nutrient media makes it possible to determine the type of infectious agent and its resistance to antibiotics.

Therapeutic techniques

Treatment of osteomyelitis of the jaw is aimed at eliminating the source of infection in the bone and surrounding tissues and correcting functional disorders. Therapy is carried out in a hospital setting.

The most effective method is sequestrectomy - surgical removal of the affected tissue, followed by sanitation and drainage of the cavity. It is necessary to treat osteomyelitis with the use of antibacterial drugs that suppress the activity of the infectious agent. Antibiotic treatment lasts 7–14 days.

Additionally, painkillers and anti-inflammatory drugs are prescribed. In the early postoperative period, bed rest and a special diet are indicated. Food should have a liquid or semi-liquid consistency.

During surgical treatment of osteomyelitis, several teeth must be removed. This leads to the need for further prosthetics. Excision of a large amount of bone tissue contributes to jaw deformation.

Damage to surrounding tissues often results in scarring, which becomes a serious problem requiring the intervention of a plastic surgeon.

Recovery from osteomyelitis can take several years. All patients should be under medical supervision until functional disorders are completely eliminated.

The rehabilitation plan includes the use of:

• physiotherapeutic procedures;
• prosthetics of extracted teeth;
• repeated surgery;
• treatment of concomitant diseases.

Proper prevention reduces the risk of relapse and the development of dangerous complications. It is necessary to promptly eliminate foci of infection in the form of carious teeth. A normal immune system is maintained through proper nutrition and a healthy lifestyle.

After tooth extraction or injury, you must follow all recommendations of your doctor.

Despite the constant development of medicine, cases of osteomyelitis in children and adults are not so rare. Its timely detection and treatment provide a chance for a full recovery.

After damage to bone tissue, the body’s immune system tells leukocytes that the inflammatory process is in full swing, and they rush there en masse, releasing special enzymes that decompose the bone.

As a result of inflammation of the bone tissue, pus is formed, which begins to spread through the blood vessels, causing the affected tissue to be rejected from healthy tissue. This creates the basis for the occurrence of chronic infection. Trying to normalize the situation, the body begins to try to create new bone tissue around the affected one. Such bone, obtained as a result of the restoration work of the immune system, is called the integument.

When screening bone tissue, the presence of the cover allows us to understand the nature of the process - acute or chronic form of the disease.

Osteomyelitis is a process that is infectious in nature, spreading to the entire bone, including the bone marrow. In the chronic course of the disease, this can lead to bone deformations and sclerosis.

The disease often causes arthritis. The bones of the femur, lower leg, vertebrae, humerus, as well as the upper jaw and mandibular joints are most sensitive to it. Bone necrosis is often caused by Staphylococcus aureus. In this article we will talk about damage to the bone tissue of the jaw (osteomyelitis of the jaw). In particular, the course of the disease that occurs after the removal of a wisdom tooth will be considered.

Forms of osteomyelitis of the jaw

There are three main forms of osteomyelitis of the jaw: traumatic, odontogenic and hematogenous. Each form is characterized by the source of infection. The form that is most often found in medical practice is the odontogenic one; a little less often people get the traumatic form. The rarest form of osteomyelitis is hematogenous. This form mainly affects young children aged one to three years.

The most common type (form) of the disease is usually caused by a complication of dental caries, periodontitis and pulpitis.

Often the disease occurs against the background of medical errors, for example, after the removal of a wisdom tooth or during prosthetics of other teeth.

Cases of manifestation of the disease

The picture of the development of the disease caused by carious lesions of tooth tissue is as follows: pathogenic bacteria enter from the cavity affected by caries into the dental canal. From there they freely penetrate into the bone funnel. From it, pathogenic bacteria enter the capillary system and bone trabeculae (beams), rapidly multiplying along the entire route.

As mentioned earlier, the immune system responds by summoning an “army” of white blood cells that actively fight foreign bacteria, infecting them and killing them. As a result of such “combat” actions, a mass of dead leukocytes is formed - pus.

In addition to Staphylococcus aureus, the causative agent of infection can be other staphylococci, anaerobic bacteria and streptococci.

It is curious that this form of osteomyelitis often plagues the male half of humanity, who are between the ages of twenty and forty years.

Another example of the occurrence of an odontogenic form of the disease is the abnormal growth of a tooth, for example, it could be an ordinary wisdom tooth. In this case, the gums will most likely be deeply inflamed and cysts may even form. The described picture is a direct indication for the elimination of a diseased tooth.

Tooth extraction

After the removal of a diseased wisdom tooth, a deep hole (funnel) is formed in the gum. It happens that it does not last for a very long time and constantly hurts. Therefore, osteomyelitis after tooth extraction is a completely acceptable phenomenon, and here’s why.

It is worth taking into account: after any surgical intervention, some areas of gum tissue are forcibly destroyed, increasing the likelihood of bleeding and inflammation. If an infectious agent gets into the wound, it becomes infected, suppurates, and there is a risk of developing serious diseases such as osteomyelitis of the jaw or an abscess.

However, after a wisdom tooth is removed, a person may experience other complications. For example, fainting or loss of consciousness for some time. This happens if a person has experienced severe stress or painful shock. Any professional dentist will definitely provide assistance in such a situation.

Also, after the removal of wisdom teeth, the socket (“funnel”) may bleed, some fragments of the tooth may remain in the gum, alveolitis and even loss of sensitivity in the gum tissue may occur. And the most common complication after the removal of a wisdom tooth, as well as other teeth, can be an increase in body temperature to thirty-eight degrees Celsius. This usually occurs in severe cases, when osteomyelitis of the jaw has already progressed, or the tooth itself is located in a hard-to-reach place.

It is quite possible that after the removal of an incisor or wisdom tooth, the gum tissue will become inflamed, which will cause an increase in temperature. However, the process of inflammation, which occurs without infection of the wound by pathogenic microorganisms, is only a reaction to injury. Therefore, the appearance of fever after the removal of a wisdom tooth, as well as other teeth, can be classified as complications only conditionally.

If the temperature does not go away within several days, an unpleasant odor appears from the sore spot, the teeth adjacent to the socket begin to loosen, the lymph nodes in the neck become enlarged, and the pain intensifies, then you need to consult a doctor. This is how osteomyelitis of the jaw manifests itself.

Forms of the disease

Let us briefly consider other forms of the disease. The hematogenous form of the disease usually progresses when the pathogen is transferred from the affected area to healthy tissue through the bloodstream through blood vessels. This form can develop on the basis of a chronic disease of the oral cavity, for example, as often happens, tonsillitis (inflammation of the tonsils of the palate).

The disease can also be a consequence of such serious illnesses as scarlet fever and diphtheria. If we take teeth as an example, the disease first affects the jaw bone and only then covers the teeth. As already mentioned, it does not occur often and mainly in childhood.

The traumatic form of the disease is even less common and usually occurs after infection of facial tissues or fractures of the jaw bones, including after wounds from a firearm.

Symptoms

Let's look at the symptoms and treatment of this disease.

It is worth noting that the upper jaw is more susceptible to hematogenous osteomyelitis than the lower jaw. This is due to some features of its blood supply. In the odontogenic form, the lower jaw is more often affected than the upper jaw.

The acute form of the disease differs from the chronic form in a pronounced pattern. The latter may have weak signs or none at all. The acute form of the disease is characterized by pain and tissue swelling. The patient's lymph nodes in the neck and lower jaw are enlarged, the temperature often jumps, and a depressed state is observed. The teeth, the first to suffer from the disease, begin to loosen, and pain appears when pressure is applied. In addition, fistulas and spasms of the head muscles may appear. The lower lip partially loses sensitivity, and the symmetry of the lower jaw is also possible.

Diagnostics

In case of osteomyelitis of the jaw, after examination by a doctor, blood and jaw tissue tests are prescribed. A high level of ESR and an increased concentration of white blood cells (leukocytes) will be recorded in the blood. Blood biochemistry will show a reduced ratio of albumin and globulins, which is typical for the body to produce a protective reaction (special antibodies). C-reactive protein levels are likely to rise significantly, and fibrinogen levels will also be high.

In the presence of fistulas, the secretions secreted by them are collected to screen microflora and identify resistance to antimicrobial drugs.

A mandatory element of diagnosis is an x-ray of the jaw bones.

If the disease is acute, then the scan will most likely not show anything. After a week, when a lot of pus has already begun to be produced, necrosis of bone tissue can be distinguished in the photographs - thinning of the surface layer of the bone.

The chronic process is characterized by local resorption of bones. Moreover, bone destruction occurs both externally and internally. However, at the very beginning, no dead areas are visible in the photographs. Subsequently, specific “veins” of the affected areas of the bone are clearly visible on them. The presence of foci is recorded in the area of ​​the periosteum. The inflammatory process occurs slowly in the body with frequent tissue growth and the release of purulent secretion. This form of the disease is difficult to treat.

Often, X-ray examinations are combined with additional monitoring - computed tomography of the skull. It is necessary to accurately determine the location and size of foci of necrosis. These studies can also provide an accurate three-dimensional picture of the bone structure.

Treatment

The treatment of the disease is approached comprehensively. Usually antibiotics, drugs that eliminate toxicity of the body, and surgical intervention (tooth extraction, dissection of the periosteum) are prescribed. To relieve pain, painkillers and anti-inflammatory drugs are prescribed.

In the odontogenic form of osteomyelitis that occurs after the removal of a wisdom tooth, the period of time following the operation is quite dangerous for the patient, because the wound may fester again. Taking antibiotics will help prevent this.

It happens that in order to remove the source of infection, it is necessary to cut the periosteum and remove the diseased area of ​​bone tissue. The resulting cavity in the bone tissue is treated with antiseptics and then sutured.

There is a disease that combines inflammation, infectious infection, tissue necrosis, and occurs in the jaw bone, close to the facial muscles, mucous membrane, facial skin, main arteries, respiratory tract, and a huge number of lymph nodes. This disease is called osteomyelitis of the jaw. What kind of disease is this and why is it so dangerous?

The disease is difficult to diagnose due to symptoms related to other diseases. It can lead to serious diseases of internal organs, deformation and fracture of the jaw, blood poisoning and even death.

Osteomyelitis is a process that occurs in the bone, bone marrow, and soft tissue surrounding the inflammation. The word “osteomyelitis” is Greek, formed from three different words - “bone”, “brain” and “inflammation”, which accurately conveys the essence of the disease.

Osteomyelitis is caused by pus-producing bacteria and mycobacteria. The disease is dangerous because the infectious process can invade the entire bone, bone marrow, lead to necrosis, deformation, entail many unpleasant consequences and concomitant diseases, and become chronic.

Osteomyelitis of the jaw is also called necrosis of the jaw. This is an extremely dangerous disease. The fact is that, unlike osteomyelitis of other bones, which is caused by just one type of bacteria introduced into the blood only through the blood (most often streptococci and staphylococci), osteomyelitis of the jaw is distinguished by a huge number of infection options and a variety of pathogens. These can be staphylococci (golden and white), pneumococci, streptococci, E. coli or typhoid.

The disease affects not only the jaw, but also the entire skeletal system. Leukocytes immediately begin to “treat” the infection in the bone, and the products of their treatment begin to decompose the bone. Purulent cavities form in the bone, necrosis begins, the jawbone becomes fragile, deformed and can break.

In addition to the bone, the soft tissue surrounding it can become inflamed - gums, nearby muscles, salivary glands, facial skin. In the absence of timely treatment, the infection spreads throughout the body. With osteomyelitis of the upper jaw, inflammation can quickly spread to the orbits, and swelling begins. Lymph nodes quickly respond to inflammation in the body. In severe cases, ulcers develop in the soft tissues of the face.

There are many ways in which osteomyelitis can occur. These can be protracted or chronic infectious and viral diseases that are not completely cured or occur with complications, dental diseases, infections with inflammation, tooth extraction, blood transfusions, severe injuries - wounds and fractures. The resulting injuries can be not only in the jaw itself; with certain types of infection, the infection can penetrate into the jaw later.

Most often, men suffer from osteomyelitis of the jaw, but it is most dangerous for young children, in whom the disease develops rapidly and its diagnosis is difficult. How to diagnose osteomyelitis and begin proper treatment? What types of osteomyelitis of the jaw occur?

Prevention

To prevent osteomyelitis, you should first of all carefully monitor oral hygiene. It is important to treat upper respiratory tract diseases in a timely manner and avoid injury.

If you do not consult a doctor in time, the disease can become chronic and cause complications with irreversible changes in the body.

Types of osteomyelitis of the jaw

There are many types of osteomyelitis of the jaw; they are determined depending on where, how, for what reason and with what consequences the infection occurred.

First of all - localization. Osteomyelitis of the jaw can develop in both the upper and lower jaw. Because the mandible is mobile, it is more susceptible to infection, so osteomyelitis of the mandible is more common. Judging by the statistics, osteomyelitis of the upper jaw is more common in children and is more difficult to diagnose, but with proper treatment it goes away easier and faster.

Osteomyelitis of the jaw can be diffuse and limited. Limited - if the localization of infection is only on the bone and bone marrow. If the infection spreads to the surrounding soft tissues, into the blood, then this is a diffuse type of disease.

By method of infection

Infectious

Osteomyelitis is caused by an infection in the jaw bone. At this moment, cavities form in the bone, usually filled with pus, which deform and destroy the bone, transfer to soft tissue, and sometimes into the blood. Depending on the bacterium that caused the disease, infectious osteomyelitis is divided into specific and nonspecific. If the cause of osteomyelitis of the jaw is typical bacteria (streptococci and staphylococci), then such osteomyelitis is called nonspecific. Specific osteomyelitis is an infection with syphilitic, actinomycotic or tuberculosis bacteria.

Most often, infection occurs due to complications of stomatitis and other dental diseases. Through the affected tissue, the infection penetrates into the pulp and through the root of the tooth reaches the jaw. It can also occur if benign tumors are not treated.

Traumatic (non-infectious)

The cause of the disease is trauma - a fracture, wounds through which bacteria that cause infection penetrate into the wound. Most often this is a facial bone injury.

Traumatic osteomyelitis of the jaw is especially distinguished after tooth extraction, when the dental nerve is not completely removed and suppuration of the cavity begins. The tooth may not be completely removed according to the dentist’s indications.

This also includes the radiation type of osteomyelitis - when the jaw bone is damaged by a malignant tumor. May occur due to a course of radiation or chemotherapy. Sometimes it starts with incorrectly made prosthetics.

Osteomyelitis infection can be affected by iatrogenic causes - this is a deterioration in a person’s condition, unintentionally provoked by a physician. There are many medical operations that can cause infection in the jaw - both mandatory and cosmetic. Dental prosthetics, tooth extraction, filling, jaw fracture treatment, facial plastic surgery. There is always a risk of infection, but it is important to remember that osteomyelitis can only begin and spread in people with low levels of immunity. Therefore, it is extremely important to maintain immunity and take care of your body.

Hematogenous

It occurs when an infection spreads throughout the body through the blood, most often due to purulent diseases such as boils and sore throat. An infectious disease (scarlet fever, influenza, respiratory diseases and others) can also cause complications with subsequent infection. Most often develops in the chronic form of the disease.

Sometimes allergic osteomyelitis of the jaw is also isolated, when infection begins due to an allergy attack that triggers the process of inflammation and suppuration. But this type of osteomyelitis also directly depends on the immune system and begins only if the body is weakened.

According to the nature of the flow

Acute form

The acute form of the disease begins quickly and is characterized by an immediate rise in temperature to high levels of up to forty degrees, all signs of inflammation, and swelling of the face. The patient shakes with chills, his face turns red, the tissues swell, the headache radiates in different parts of the head, mainly in the temple, eye socket, and cheek. Acute osteomyelitis is the easiest to diagnose because its symptoms are the most obvious. A similar set of symptoms is characteristic of tumors - benign and malignant, various pains in the teeth, and inflammation of the gums.

Pre-acute

Preacute osteomyelitis is the next stage after acute, signs of inflammation begin to disappear, but the inflammatory process continues. At this point, it is necessary to continue treatment, otherwise there is a high risk that the disease will progress to the chronic stage, the most dangerous.

Chronic

Chronic osteomyelitis does not necessarily follow from acute osteomyelitis. If the disease has become chronic from untreated osteomyelitis or due to weak immunity, which does not allow one to immediately defeat the disease, this type is called secondary chronic, it is secondary after acute osteomyelitis. This chronicle shows mild symptoms and is characterized by outbreaks of exacerbations and periods of “calm.” Fistulas appear through which pus flows from the source of inflammation, but the source of inflammation itself begins to spread throughout the body and can spread to internal organs, blood, and destroy necrotic jaw bone.

Primary chronic osteomyelitis is difficult to diagnose, since the patient has not previously experienced attacks with exacerbation of the disease. This type of osteomyelitis most often occurs in children whose primary teeth are replaced by permanent teeth at the age of five.

There is a special type of osteomyelitis of the jaw, which is called desmorphine. It occurs only in drug addicts who receive the drug through injections. When the drug affects the blood supply, the jaw festers, collapses, the bone becomes brittle, easily breaks, becomes deformed, and the face becomes asymmetrical.

Rare forms of osteomyelitis of the jaw

Recurrent

Recurrent multifocal form, in which foci of inflammation appear in the bone, but with no suppuration or infection. The disease is difficult to define because it is characterized by periods of attenuation and progression.

Osteomyelitis Garre

Garre's osteomyelitis - osteosclerosis is visible on the x-ray, the tissue is not very compacted, inflammation and infection in the bone are mild. Difficult to diagnose.

Brody's abscess

Brodie's abscess - there are practically no external symptoms of the disease, and this is why it is especially dangerous, because it is accompanied by the formation of purulent areas in the jaw bone. This disease is a type of bacterial osteomyelitis in a chronic form. In this case, x-rays will not give a clear picture of the disease, because inflammation cannot always be determined on x-rays, and areas filled with pus cannot be accurately diagnosed. It can begin not only in the jaw bone, but in any bone in the body. There are also no characteristic features of the patient - the disease can begin at any age, but more often in males and in childhood.

Osteomyelitis Ollier (Olle) is a disease caused by staphylococcus, a rather rare form of osteomyelitis, since the non-purulent areas formed with it are characterized by a high protein content.

The disease belongs to the chronic form of osteomyelitis. A very rare, almost unique disease, most often found in adolescents and children.

Most often it begins not in the jaw bone, but in the femur. Does not lead to suppuration and is characterized by a high protein content in the cavity. It is also difficult to diagnose.

The pain that appears slowly begins to grow and intensify if the body experiences stress. A swelling appears around the area with the protein-filled cavity, which increases in size and sometimes turns red.

Symptoms of osteomyelitis

Symptoms of osteomyelitis are determined depending on its type. The acute form of the disease is characterized by the following symptoms:

• a sharp increase in temperature to 39-40 degrees;
• feeling of “coated” tongue;
• headache, weakness;
• sleep problems;
• loss of appetite;
• ulcers appearing on the face;
• change in color of the mucous membrane - it becomes paler;
• inability to close the jaw.

The pain can radiate to other parts of the head - the ear on the affected side, the eye socket, the temple. The face swells, becomes deformed, and the teeth on the sore jaw begin to “loose” in the gum when pressed. It is difficult to eat and speak, and moving the jaw causes pain.

In an extremely rare, toxic form of acute osteomyelitis, high fever causes confusion and loss of consciousness.

If acute osteomyelitis begins on the upper jaw, the inflammation often spreads to the cheek and orbit. Osteomyelitis of the upper jaw most often occurs in children when changing baby teeth, and suppuration in the orbit makes diagnosis difficult.

Symptoms of preacute osteomyelitis are less pronounced. Fistulas are formed through which pus comes out, the pain subsides, the teeth above the source of inflammation become more mobile. The sick person feels better and believes that the disease is going away, while the inflammation continues to intensify and spread throughout the body.

Chronic osteomyelitis, especially its primary form, is even more difficult to identify by symptoms. This should be done by a specialist using tests and x-rays.

Symptoms of osteomyelitis of the jaw in children

The symptoms of the disease are especially noticeable for children under five years of age. At this age, baby teeth are replaced by permanent ones, and children are just learning how to brush their teeth properly, so there is a high risk of a rapidly developing infection. If baby teeth become infected, the disease can spread and destroy the buds of permanent teeth. But when making a diagnosis, it is important that the doctor perform a biopsy and exclude the possibility of a malignant neoplasm.

As in adults, children's temperature rises sharply, the face swells, the skin becomes painful and turns pink. Lymph nodes enlarge, swelling spreads to the neck and can cause the airways to close, making it difficult for a person to breathe. When the body becomes infected, the load shifts to the blood and internal organs, the liver and spleen suffer, and kidney problems begin. The disease can lead to complications and even death.

Diagnostics

X-ray examination does not always immediately help in diagnosis: the bone becomes more transparent only after fourteen days. But you can immediately see the inflammation and begin treatment.

Secondly, the following tests are collected:

• blood test for inflammation, protein, leukocytes;
• urine test.

Treatment

First of all, after establishing the correct diagnosis, it is necessary to hospitalize the patient. It is best to choose large clinics where the diagnosis will be more accurate.

Treatment of osteomyelitis due to injury or a broken tooth should begin with surgical intervention - eliminating the consequences of the injury, removing tooth fragments. Only after this the patient is transferred to traditional antibiotic treatment.

The patient is prescribed antibacterial therapy, antibiotics, intoxication, vitamins and immunostimulants, transfusions of plasma and other blood substitutes. Often osteomyelitis appears together with concomitant diseases or complications, and in this case they must be treated in a mandatory complex. If the cause of the disease is injury, the consequences of the injury are first eliminated and only then treatment begins. The condition of internal organs to which inflammation may spread, as well as the condition of the blood, should be monitored to prevent the possibility of sepsis.

First of all, suppuration is removed and the spread of tissue necrosis is stopped. Inflamed bones become fragile and can break with little effort, which deforms and disfigures the face, so treatment begins as early as possible.

To combat suppuration, hemosorption and hyperbaric oxygenation are sometimes used.

During hemosorption, the blood is purified from poisons and harmful substances by passing it through sorbents that absorb poison and harmful substances from the blood. Hyperbaric oxygen therapy is a treatment in a pressure chamber that increases the amount of oxygen in the blood. The treatment method helps to saturate soft tissues susceptible to necrosis with oxygen, and to conduct oxygen in the blood in case of onset of blood sepsis and septic shock.

Antibiotics are immediately prescribed - the sooner the fight against inflammation begins, the more effective it will be.

In the future, physiotherapy is prescribed and courses of antibiotics are continued. If the symptoms disappear, you cannot stop the course of treatment: the disease can go into a latent chronic phase and bring much more negative consequences.

If your face is deformed, you may need the help of a plastic surgeon.

Consequences of osteomyelitis

An infection affecting the jaw gradually destroys tissue and can lead to irreversible consequences for the body. Treatment should begin with the appearance of the first signs of the disease, even if they are not clearly expressed. What consequences can untreated osteomyelitis lead to?

Abscess

An abscess is a purulent inflammation of tissue. It can develop in muscles, bones, fiber, and organs. It occurs both as an independent inflammation and as a consequence of diseases. When an infection enters through skin or mucous membranes damaged during osteomyelitis, the body reacts by enclosing the purulent focus in a capsule and thereby protecting healthy tissue.

Phlegmon

The word "phlegmon" comes from an ancient Greek word meaning "heat, inflammation." Like an abscess, this is a purulent inflammation, but, unlike an abscess, it is not clearly limited. Pathogens also penetrate the fiber through damaged tissue or from foci of infection, sometimes through the blood.

Contracture

Contracture is a restriction of joint movement. Healed tissue prevents bending and straightening joints, reduces the mobility of muscles and skin - in the case of consequences of osteomyelitis, this reduces the mobility of the lower jaw or facial muscles. Contracture of the lower jaw is especially dangerous, because in this case a person is deprived of the ability to speak and chew food independently.

Pulmonary (and respiratory) failure

Under this name there is a whole complex of symptoms in which respiratory functions are disrupted and the body does not receive enough oxygen. Complications after osteomyelitis can be different - swelling of the upper respiratory tract, which prevents the supply of oxygen to the lungs, infectious lesions of the spinal cord (and, as a result, paralysis), diseases of the circulatory system due to the onset of sepsis.

Kidney amyloidosis

Disturbance of protein metabolism, which as a result can lead to edema and kidney failure. The first weeks are hidden, all the symptoms that appear are only weakness and fatigue, which may not be very noticeable against the background of inflammation.

Meningoencephalitis

Meningoencephalitis, very similar to meningitis, is an inflammation of the brain that can cause paralysis if it spreads to the spinal cord. Headache, chills, vomiting, nausea - all this begins suddenly and develops very quickly. It is important to diagnose meningoencephalitis against the background of osteomyelitis in time and begin treatment.

Phlebitis

Phlebitis is an inflammation of the veins that disrupts blood circulation throughout the system. It can also begin due to an infection that has entered the circulatory system.

Sepsis and septic shock

One of the most unfavorable consequences of osteomyelitis for the body. Blood poisoning and a serious condition of the body in which oxygen and other substances are not delivered to the tissues. Children, people with weakened immune systems, and the elderly are especially at risk. Death occurs in between a quarter and half of cases of the disease.

In children, osteomyelitis of the jaw develops much faster than in adults, so it is extremely important to take children to the dentist prophylactically and to be especially careful at the age of 4-6 years when changing baby teeth.

Conclusion

Osteomyelitis of the jaw is the most common, and it is also dangerous precisely because of its complications and consequences. Pain in a tooth or slight suppuration on the gum, pain radiating to the ear or temple, general weakness and high temperature - many people prefer to treat all this with painkillers without contacting a specialist. Chronic primary osteomyelitis does not give a clear picture at all, and it is impossible to identify it without tests and an x-ray. The symptoms are difficult to diagnose because the symptoms of osteomyelitis are in many ways similar to the symptoms of malignant tumors that appear in the jaw bones - they are also often ignored until the last moment.

Osteomyelitis of the jaw is actually a disease of a neglected and weakened organism. Inability to maintain oral hygiene, a reduced level of immunity, untreated colds and respiratory diseases, injuries that were not disinfected in time, infection through drugs, lack of systematic visits to the dentist - all these are the best friends of the development of osteomyelitis of the jaw.

Medical science calls osteomyelitis an inflammation of the bone that involves adjacent soft tissue and bone marrow. With it, pus is always released, and the infected cells gradually die. The hardest thing for a person to endure is acute osteomyelitis of the jaw - the initial stage of the disease. Whatever the form of the disease, if it is not treated properly, the inflammatory process will become chronic and can affect other vital organs.

Osteomyelitis of the jaw: causes

The development of purulent inflammation in the jaw bone is provoked by one of three factors:

• inflammation of teeth or surrounding tissues;
• jaw bone injury;
• infection of other organs.

In connection with such a clear grouping of the causes of the disease, its strict classification arose:

1. Post-traumatic osteomyelitis. The infection enters the bone of the upper or lower jaw as a result of injury.
2. Odontogenic osteomyelitis (80% of cases). Infection of the jawbone is caused by: inflammation of the pulp, periodontium or gums. A granuloma or a cyst that develops from it can also be a provoking factor.
3. Hematogenous osteomyelitis. Dental damage in this case is not the cause of the disease, but a consequence. The infection penetrates deep into the jaw bone through a blood stream that carries pathological elements from purulent foci on the face, in the nasopharynx, ears or in the umbilical cord in newborns. Dangerous infectious diseases such as diphtheria and scarlet fever can also cause the disease.

Predisposing factors to the occurrence of inflammation in the bone are: diabetes mellitus, rheumatism, polyarthritis, blood, liver and kidney diseases. In addition, osteomyelitis often occurs due to severe or prolonged stress, vitamin deficiency and treatment with the use of immunosuppressive drugs.

Additional information. According to some data, osteomyelitis of the upper jaw is diagnosed 3–4 times less often than osteomyelitis of the movable bone of the skull.

Classification of osteomyelitis of the jaw

The main classification of maxillary osteomyelitis is not related to the causes of the disease, but to the characteristics of its course. Although treatment methods are influenced by both. Thus, medical science identifies the following types of osteomyelitis of the jaw:

• Spicy- characterized by the sudden appearance and vivid manifestation of symptoms.
• Subacute- occurs in the absence or poor quality of treatment of the acute form and is characterized by a decrease in the severity of symptoms.
• Chronic- develops from acute osteomyelitis (sometimes immediately), characterized by the disappearance of the main symptoms. Exacerbation of inflammation is inevitable.

Another important clarification that the attending physician makes in the medical history is the prevalence of the focus of the purulent-necrotic process. In this regard, two forms of maxillary osteomyelitis are distinguished:

• limited - the area of ​​inflammation covers a part of the bone that is occupied by no more than four teeth;
• diffuse - the length of the affected area exceeds the area where four teeth are located, and can occupy the entire jaw.

Pay attention! The transition of the disease to a chronic form does not mean that it has receded. If the treatment of osteomyelitis is not completed, it will gradually progress and spread, which is fraught with irreversible changes.

The hardest thing for a person to endure is acute inflammation of the jaw bone, which occurs due to the spread of infection from distant foci (hematogenous type). The load on the body in such a situation is especially great. At first, the acute form of osteomyelitis is difficult to identify due to the fact that pronounced general signs of the disease predominate.

Acute osteomyelitis of the upper and lower jaw is characterized by the following symptoms:

• pain at the site of inflammation, radiating to the upper or lower part of the face and even an area extending beyond its limits;
• migraine, insomnia, malaise, loss of appetite;
• high body temperature, problems with blood pressure;
• redness and swelling in the mouth;
• enlargement and tenderness of the submandibular lymph nodes;
• problems with jaw movements;
• pale skin, worsening facial features;
• numbness of the lips, spasms of the facial muscles, swelling of the face.

Additional information. The most difficult thing to detect is osteomyelitis after a jaw injury. Its presence is indicated by an increase in pain and signs of intoxication of the body several days after the injury.

Subacute form Osteomyelitis of the jaw is characterized by subsidence of symptoms to a significant extent. This change occurs during the treatment process after the bone is cleansed of pus. At this stage, therapy cannot be stopped, since the inflammatory process does not stop, although it becomes sluggish. The patient continues to suffer from weakness and insomnia, and the skin remains pale.

Chronic osteomyelitis of the upper and lower jaw develops as a result of the complete absence or incorrectly selected therapy or the patient’s reluctance to treatment. Pain syndrome occurs only during exacerbation of the disease. The rest of the time (during remission), slowly progressive inflammation has the following manifestations:

• the general condition of the patient has signs of intoxication;
• fistulas periodically appear in the mouth and face with the release of pus in small quantities;
• infected teeth become loose;
• mucous membranes in the mouth swell;
• the lymph nodes in the upper part of the neck become enlarged.

Diagnostics

Diagnosis is made based on symptoms and test results. In acute osteomyelitis, an increase in leukocytes, ESR, C-reactive and total protein will be detected in the blood. The level of eosinophils and albumin will be reduced. Red blood cells and proteins will be found in the urine. Using bacteriological culture, a specialist will identify the causative agent of the inflammatory process.

Due to the mild severity of symptoms, subacute and chronic osteomyelitis of the jaw is much more difficult to diagnose. Tomography and radiography will be required. The acute and chronic stages of the disease can easily be confused with inflammation of the periodontium and periosteum, jaw tumor, as well as syphilis and tuberculosis.

Possible complications

If the patient does not receive timely assistance or treatment of osteomyelitis is ineffective, life-threatening complications may develop. Inflammation in the upper jaw usually spreads upward and affects the eyes and brain. Chronic osteomyelitis of the lower jaw leads to infection of the lungs.

In addition, inflammation in the soft tissues of the neck and face or deformation of the jaw bone may develop. In rare cases, it breaks. Advanced inflammation can cause the infection to spread through the bloodstream to other organs. The teeth are usually the first to be affected.

Treatment of the disease

The qualifications of the specialist play a special role. Based on a thorough examination and examination, he must decide which therapeutic method is applicable in a given case. Osteomyelitis is treated mainly with hospitalization.

Pay attention! If you have osteomyelitis of the jaw, you should consult a surgeon for treatment. This could be a general practitioner or a dentist. It is best to get qualified help from an oral and maxillofacial surgeon, but not every city can find departments with such highly specialized specialists.

Treatment algorithm

1. Elimination of the source of infection (removal of an infected tooth in odontogenic osteomyelitis).
2. Removal of pus and antiseptic treatment of bone and soft tissue.
3. Cutting out dead tissue during the disease process.
4. Antibacterial and antiviral therapy (antibiotics are selected based on the results of bacterial culture).
5. Detoxification and immunomodulatory therapy.

All surgical interventions are performed under local anesthesia. The resulting wounds are constantly treated with antiseptic solutions. If the disease has led to loose teeth, they will need to be strengthened by splinting during treatment. The specialist conducting the treatment can additionally prescribe to the patient some types of physiotherapeutic procedures (UHF, ultrasound), as well as means to eliminate the symptoms of the disease.

It is impossible to treat osteomyelitis of the jaw at any stage with traditional methods. However, using them as an addition to primary therapy can be very effective. What do traditional healers offer to combat this dangerous disease?

• Shilajit solution - taken orally helps in the rapid healing of wounds and restoration of damaged tissues.
• Propolis solution - rinsing helps in the healing of fistula tracts.
• Salt solution - rinsing has a healing effect.
• A decoction of herbs (chamomile, calendula, string) - rinsing is an aid in the healing of fistulas.

Adherents of homeopathic remedies can also choose the right remedy for a speedy recovery. The following drugs are popular: “Stillingia”, “Acidum fluoricum”, “Aronea diadema”, “Mercurius solubilis”. It is best to seek help from a professional homeopath.

Additional information. It is very important that during the treatment the patient consumes plenty of fluids, as well as high-quality foods high in vitamins and proteins. After each meal, he needs to thoroughly clean his mouth.

Forecast and prevention of osteomyelitis of the jaw

If the patient seeks help at the first signs of the disease, before osteomyelitis becomes chronic, skillfully selected treatment will completely stop osteomyelitis of the jaw. There is no need to worry about the development of complications in such a situation. They are only possible if the disease is not treated immediately. If the lesion is extensive, jaw deformation may subsequently occur.

Preventive measures:

• timely treatment and dental prosthetics;
• regular visits to the dentist;
• timely treatment of infectious diseases (especially respiratory diseases);
• preventing facial injury;
• quality oral cavity;
• immune support.

Osteomyelitis of the upper or lower jaw usually develops in people who do not strive to maintain their health with all their might or in those who have received weak immunity from birth or due to illness. In very rare cases, the cause is injury. Most often, the disease in question is a complication of diseases of the teeth and gums. This is why it is so important to pay special attention to oral care and not delay necessary treatment indefinitely.

Video: osteomyelitis of the jaw