Comprehensive Maxillofacial Osteomyelitis

Introduction

Deepak Gupta, Soheyl Skeikh, Shambulingappa Pallagatti

Abstract

Osteomyelitis of the jaws is a challenging disease for the clinicians and the patients despite many advances in the diagnosis and treatment. It was a common and dreaded disease in the past because of its prolonged course and uncertainty of outcome. It is an interesting fact to know that the oral cavity is among the most biologically dynamic tissues of human body. Any adverse change arising from any immunosuppressive systemic disease will readily manifest itself in the oral cavity. Osteomyelitis is not an exception to this. Thus, a careful evaluation of an apparently healthy individual presenting with a jaw swelling that may be associated with odontogenic infection must always be emphasized. This particular chapter will provide a brief introduction to the Osteomyelitis of the jaws so as to orient the readers towards the disease, its etiopathogenesis and clinicopathological features.

Keywords: Etiopathogenesis, Inflammation, Mandible, Maxilla, Osteomyelitis of the jaws.

Osteomyelitis is an inflammation of the medullary portion of the bone. It usually also affects the cortical bone and periosteum. The process is rarely confined to the endosteum. Therefore osteomyelitis may be considered as an inflammatory condition of the bone that usually begins as an infection of the medullary cavity, rapidly involves harversian systems and quickly extends to the periosteum area [1].

The word osteomyelitis is made up of a combination of two or three small words. The word OSSEOUS in Latin means bony, while OSTEON in Greek means bone. MYELOS in Greek means marrow; and ITIS in Greek means inflammation [2].

In the past, osteomyelitis of jaws like that of long bones was believed to be caused primarily by Staphylococcus aureus, Staphylococcus epidermidis, or hemolytic streptococci. But in recent years, several anaerobic bacteria have been identified thus adding to the number of microbiologic agents involved in the disease [1]. It has been found that 93% percent of the osteomyelitic infections of the jaws are polymicrobial with an average of 3.9 organisms per specimen [1].

The most common and possible predisposing factors that should be considered for osteomyelitis to occur include irradiation, immunosuppressant treatment, malnutrition, and metabolic bone disease [2]. It can also be precipitated by Paget’s disease of bone, fibrous dysplasia and bone tumors [3].

Infection with human immunodeficiency virus must also be considered as a precipitating factor to osteomyelitis as it diminishes body’s natural defense mechanisms