Лечение остеомиелита челюсти: антибиотики, хирургия, процедуры

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Есть много стоматологических заболеваний. Причем многие из них значительно серьезнее и опаснее привычного и распространенного кариеса.

Одним из таких заболеваний является остеомиелит, который имеет гнойно-инфекционную природу и грозит серьезными осложнениями, если вовремя не начать лечение. Именно на такое поражение челюстей приходится почти треть всех случаев остеомиелита.

Что представляет собой заболевание?

Заболевание одно из самых опасных, поражающих кости. При нем воспалительные и инфекционные процессы захватывают не только все слои кости, но также и окружающие ткани.

Иногда этот процесс приводит к генерализации заболевания. В этом случае разрушительные явления поражают всю костную систему.

Изначально остеомиелит считается воспалением костного мозга. Однако процесс некротизации и воспаления распространяется дальше – захватывает полностью все компоненты структуры костей челюсти и мягкие ткани, которые ее окружают.

Фото: остеомиелит челюсти

 

Возбудителей у этого заболевания несколько. Среди них:

• золотистый стафилококк;
• кишечная палочка;
• синегнойная палочка;
• грамотрицательные бактерии;
• риккетсии;
• клебсиелла.

Примерно половина всех зарегистрированных случаев челюстного остеомиелита протекали на фоне проникновения в организм и развития различных вирусных заболеваний.

Причины

Для того чтобы проводить адекватное лечение, важно выяснить точную причину возникновения заболевания. Дело в том, что классификация остеомиелита во многом основана именно на причине, вызвавшей болезнь. А лечение в каждом случае отличается.

Наиболее вероятные причины остеомиелита:

• Глубокий кариес, который вызывает инфекционный процесс в зубе.
• Механические травмы челюстей (удары, сильные ушибы и прочее).
• Наличие некоторых хронических заболеваний, например, тонзиллита (воспаление одной или обеих миндалин).
• Общие острые инфекционные заболевания, например, скарлатина или дифтерия.
• Появление в зоне лица гнойных поражений, таких как карбункулы или фурункулы.
• Разного рода нарушения в работе височно-челюстного сустава.

Обязательно нужно сказать о том, что нарушения работы иммунной системы и, соответственно, значительное ослабление естественной защиты организма, является так называемым спусковым крючком для развития остеомиелита.

Поэтому прогноз всегда ухудшается, если пациент страдает заболеваниями крови, сахарным диабетом, онкологическими и подобными болезнями.

Разновидности и классификация

Прежде чем говорить о симптоматике, следует рассказать о том, какие формы принимает заболевание и о его классификации. Каждая форма имеет отдельные признаки и симптомы.

Различают четыре вида форм – хронический, подострый, острый остеомиелит, а также обострение хронической формы. Они же являются стадиями в клиническом течении.

Хронический

При таком течении болезнь обычно длится долгое время – в среднем несколько месяцев. В зависимости от естественной защиты организма и прочих факторов в такой форме остеомиелит протекает от месяца и даже до нескольких лет.

При этом будут внешние улучшения состояния. Однако в то же время болезнь на самом деле усугубляется, может формироваться новый свищ.

Кроме того, отторгаются омертвевшие участки костных тканей. При таком варианте практически никогда не бывает случаев самоизлечения.

Острая форма

Максимальная длительность периода – до двух недель. Заболевание развивается быстро, причем вначале симптомы больше походят на какое-то общее недомогание.

Подострая форма

Длится от двух недель до месяца. Чаще всего, это просто следующий этап острого остеомиелита. Так как до этого болезнь развивалась быстро, то происходят прорывы гноя из тканей кости, а это приводит ко временному улучшению состояния.

На его фоне внешне становится незаметным дальнейшее разрушение, а воспалительный процесс получается «смазанным». После прорыва гноя формируется секвестр – участок, где костная ткань уже является омертвевшей.

Обострение хроники

После улучшения наступает период, когда воспаление становится явно заметным, и весь процесс разрушения идет гораздо быстрее и явственней.

Кроме этого разделения болезни по форме течения, остеомиелит челюсти классифицируется по источнику инфекции.

• Одонтогенный – то есть, исходящий из зуба. Инфекция попадает в костные ткани из гнойного поражения какого-то из зубов. В подавляющем большинстве случаев локализуется процесс на нижней челюсти.
• Гематогенный. В этом случае источником инфекции становится кровь, которой омываются костные ткани.

  Это обусловлено происходящими в организме общими процессами инфицирования, то есть имеется хронический инфекционный очаг. Встречается редко. Течение болезни происходит «наоборот» – зубы поражаются уже от зараженной кости.

• Травматический. В данном случае причиной заболевания становятся переломы и другие подобные травмы челюстей. Чаще всего это сложные переломы, осколочные и даже огнестрельные, когда наблюдается обширная травматизация.

Симптомы

Если говорить об острой форме заболевания, то начало характеризуется появлением признаков общего недомогания. Причем они появляются резко и внезапно:

• высокая температура, доходящая до фебрильных (то есть, лихорадочных 38-39°C) значений;
• слабость;
• возникновение ознобов;
• отсутствующий аппетит;
• плохой сон.

Среди обычных симптомов можно перечислить такие:

• покраснение слизистых оболочек во рту;
• воспаление лимфоузлов;
• боль в причинном зубе;
• расшатывание зубов в районе очага инфекции;
• болевые ощущения распространяются далее – на всю челюсть, сустав, виски, глазницы;
• образование гнойных выделений в десневых карманах;
• потеря чувствительности губы, кожи подбородка и преддверия рта.

Кроме того, для каждой формы и вида болезни, а также в зависимости от локализации очага инфекции могут появляться множество дополнительных симптомов и признаков.

Терапия нижней челюсти

Лечение подразумевает множество методик, в том числе и хирургическое вмешательство. Однако это в любом случае будет сложный и чаще всего растянутый во времени процесс.

Независимо от этиологии, то есть конкретных причин возникновения, обязательно применяется комплекс мероприятий, которые направлены не только на устранение самого очага инфекции, но и на остановку всего воспалительного процесса.

Конкретные мероприятия, проводящиеся для лечения, зависят во многом от того, как именно начало развиваться заболевание. Например, при одонтогенной форме обязательно удаляется больной зуб.

Одновременно с этим должны создаваться условия для выхода гноя и полной очистки пораженной зоны, чтобы воспалительный процесс не обострился снова.

Антибактериальные препараты в обязательном порядке назначаются пациентам с острой и хронической формами остеомиелита. А вот антибиотики назначаются параллельно с проведением разного рода хирургических вмешательств. Удаление кости при этом – крайняя мера и к ней прибегают редко.

Современные методики позволяют проводить малоинвазивные вмешательства с дренированием очагов инфекции, удалением отмерших тканей, а также абсцессов и флегмонов, с последующим проведением диализа.

Еще одна современная методика позволяет вводить различные препараты, направленные на уничтожение инфекции, прямо в костные ткани. Название метода – механическая остеоперфорация.

При этом введенные препараты блокируют начавшийся процесс воспаления в определенном участке и не позволяют ему распространиться шире, захватив близлежащие ткани.

Терапия верхней челюсти

Варианты лечения этого заболевания при различной локализации – верхняя или нижняя челюсть – не отличаются. Различными при этом могут быть только последствия и само протекание болезни, то есть ее признаки.

В зависимости от определенной стадии остеомиелита также есть некоторые различия в процессе лечения. Например, острая форма всегда должна лечиться в условиях стационара клиники. Первоначально устраняют очаг, а затем проводят дезинфекционную, противовирусную, стимулирующую и общеукрепляющую терапию.

Также может проводиться иммуностимуляция, прием витаминов, кварцевое облучение и физиотерапевтические процедуры. Все зависит еще и от общего состояния организма и его способности самостоятельно бороться с инфекцией.

Стоит также сказать, что травматический или гематогенный остеомиелит требует несколько иного подхода. Здесь изначально следует устранить причину, то есть либо полностью вылечить полученные травмы, либо провести общую противовирусную терапию.

Кроме того, последствия в виде больного зуба или образованного свища устраняются хирургически, одновременно с общим лечением.

Особенности терапии хронического заболевания

Среди особенностей этой формы можно выделить секвестрацию. Это процесс отторжения некоторых участков тканей, которые омертвели. Именно поэтому в лечение обязательно входит секвестрэктомия.

Это хирургическое вмешательство, при котором отсоединившиеся участки мертвой ткани обязательно подлежат удалению. Проводят такие операции под контролем в виде рентгенограммы.

Кроме этой операции назначают простое удаление зуба, около которого находится гнойное поражение. Создаются такие условия, чтобы гной мог полностью выйти, и очищают этот участок.

Наряду с хирургическим вмешательством должно проводиться антибактериальное лечение и физпроцедуры.

В следующем видео подробно показано хирургическое вмешательство при хроническом остеомиелите:

Антибиотики и противомикробные препараты

Цель: уничтожение патогенной микрофлоры и снятие воспалительного процесса.

При первом обращении пациента назначают ставить высокие дозы антибиотиков, активных в отношении Staphylococcus aureus:

• Оксациллин;
• Нафциллин;
• Цефалоспорин;
• Ванкомицин.

Если врач подозревает наличие грамотрицательных палочек, то прописываются:

• Ампициллин: 2 г каждые 4 ч;
• Цефазолин , Цефуроксим (цефалоспорин второго поколения): 1,5 г каждые 8 ;
• Ципрофлоксацин (фторхинолон): 400 мг каждые 12ч.

При инфекции, вызванной Pseudomonas aeruginosa:

• Тобрамицин: 1,7 мг/кг каждые 8 ч или 5-7 мг/кг 1 раз в сутки.

Совместно с одним из препаратов:

• Тикарциллин: 3 г каждые 4 ч;
• Цефтазидим: 1-2 г каждые 8 ч;
• Азтреонам: 1-2 г каждые 8 ч.

Если болезнь вызвана чувствительными к пенициллинам стафилококками и стрептококками:

• Бензилпенициллин: 3-4 млн ед каждые 4 ч.

Для уничтожения стафилококков чувствительных к метициллину (и устойчивых к бензилпенициллину):

• Нафциллин: 2 г каждые 4ч;
• Оксациллин: 2 г каждые 4ч.

Остеомиелит, вызванный метициллиноустойчивыми штаммами стафилококков:

Если у пациента аллергия к пенициллинам:

• Цефазолин: 1-2 г каждые 8 ч.

Сильные антимикробные препараты взрослым внутрь не назначаются. Для домашней терапии подойдут следующие фторхинолоны, которые не уступают при оральном приеме бета-лактамным антибиотикам, вводимым в/в:

• Ципрофлоксацин: 750 мг каждые 12 ч;
• Офлоксацин: 400 мг каждые 12 ч.

Но эти препараты вызывают устойчивость возбудителей к ним, если лечить остеомиелит, вызванный Staphylococcus aureus или Pseudomonas aeruginosa.

При разновидности болезни, спровоцированной Bacteroides spp, для приема внутрь назначаются:

• Клиндамицин: 300-450 мг каждые 6 ч;
• Метронидазол: 500 мг каждые 8 ч.

Врачи узнают, принимает ли пациент таблетки по схеме, с помощью анализа МБК сыворотки.

Физиопроцедуры

Пациента направляют на процедуры после успешного устранения источника проблемы, т.е. не раньше, чем через неделю. Организму помогают справиться с последствиями болезни несколько методик: магнитотерапия, электрофорез и лазерная терапия.

Низкочастотная магнитотерапия

Низкочастотная магнитотерапия способствует ускорению заживления послеоперационной раны, за счет улучшения микроциркуляции крови в ней и повышения чувствительности микробов к антибиотикам. Было доказано, что благодаря этой процедуре даже совершенствуется строение клеток.

Используются аппараты «Полюс-1» и «Полюс-2». Медсестра ставит на очаг поражения контактные индукторы по поперечной методике. Идет пульсирующее магнитное поле частотой 50 Гц и магнитная индукция 40 мТл.

Сеанс длится от 20 до 30 мин. Требуется 30 раз.

Высокоинтенсивная импульсная магнитотерапия

Стабильная, контактная высокоинтенсивная импульсная магнитотерапия. Цель аналогична низкочастотной методике. Применяются аппараты «АМИТ-01» и «АМТ2 АГС». Выбирается интервал между импульсами 20 мс и магнитная индукция 400-800 мТл.

Сеанс длится от 10 до 15 мин. Требуется 10 раз.

Импульсная магнитная терапия

Для проведения импульсной магнитной терапии настраивают неподвижное магнитное поле частотой 5-10 Гц и интенсивностью 5-10 мТл.  Используется аппарат «Полимаг-01».

Сеанс длится от 30 мин. Требуется 15 раз.

Внутритканевый электрофорез с антибиотиками

При гальванизации создается электрическое поле, антибиотики соединяются с белковыми молекулами крови и проникают в проблемную зону. При этом под влиянием гальванического тока капилляры расширяются, благодаря чему проходимость дозы лечебной крови и антибиотиков увеличивается.

Назначенный антибиотик (например, линкомицин или гентамицин) вводится внутривенно с помощью капельницы. Одновременно на проблемное место в кости делают гальванизацию и магнитотерапию по поперечной методике.

Плотность тока 0,01 мА/см2 и интенсивность магнитной индукции 40-60 мТл. Площадь электродов и гидрофильных прокладок 400-600 см2.

Сеанс гальванизации длится 60 мин, магнитотерапии 40 мин, капельница ставится на 60 мин. Курс от 5 до 8 раз.

Электрофорез террамицина, фосфора, цинка, меди

Действие на рану аналогично процедуре с антибиотиками. Сила тока 8-10 мА.

Сеанс длится от 15 до 20 мин. ежедневно или через день. Курс 10 раз.

Инфракрасная лазерная терапия

Лабильное инфракрасное воздействие лазером частой 5-80 Гц на очаг поражения.

Сеанс длится от 10 до 12 мин. Курс 12-15 раз.

Терапия народными средствами

Самостоятельное лечение с использованием народных средств не допускается, так как болезнь обостряется и тогда последствия могут быть серьезными.

Однако народные рецепты и средства можно использовать параллельно с основным лечением. Вот несколько таких рецептов.

• Настойка арники горной. Применяется внутрь, примерно по 35–40 капель за полчаса до еды. Приготовить настойку просто – нужно залить цветы растения спиртом в концентрации 40% и дать выстояться около 10 дней.
• Компресс из лука с мылом. Несколько раз в день на 15–25 минут делают компрессы на больное место из смеси тертого лука и хозяйственного мыла.
• Убрать боль можно с помощью примочки из отварной овсяной соломы, которую плотно привязывают бинтом к болевому очагу.

 

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90000 Osteomyelitis: Symptoms, causes, and treatment 90001 90002 Osteomyelitis is an infection and inflammation of the bone or the bone marrow. It can happen if a bacterial or fungal infection enters the bone tissue from the bloodstream, due to injury or surgery. 90003 90002 Around 80 percent of cases develop because of an open wound. Symptoms include deep pain and muscle spasms in the inflammation area, and fever. 90003 90002 Bone infections commonly affect the long bones in the leg and upper arm, the spine, and the pelvis.In the past, it was difficult to treat osteomyelitis, but now, aggressive treatment can often save the infected bone and stem the spread of infection. 90003 90002 Osteomyelitis is estimated to affect 2 out of every 10,000 people in the United States at some time. In this article, we explain the treatment, symptoms, causes, and more. 90003 90002 Treatment depends on the type of osteomyelitis. 90003 90012 Acute osteomyelitis 90013 90002 In acute osteomyelitis, infection develops within 2 weeks of an injury, initial infection, or the start of an underlying disease.The pain can be intense, and the condition can be life-threatening. 90003 90002 A course of antibiotics or antifungal medicine is normally effective. For adults, this is usually a 4 to 6-week course of intravenous, or sometimes oral, antibiotics or antifungals. Some patients need treatment in hospital, while others may receive injections as an outpatient, or at home if they can inject themselves. 90003 90002 Possible side effects from antibiotics include diarrhea, vomiting, and nausea. Sometimes there may be an allergic reaction.90003 90002 If the infection is caused by MRSA or some other drug-resistant bacteria, the patient may need a longer course of treatment and a combination of different medications. 90003 90002 In some cases, hyperbaric oxygen therapy (HBOT) may be recommended. 90003 90012 Sub-acute osteomyelitis 90013 90002 In sub-acute osteomyelitis, infection develops within 1-2 months of an injury, initial infection, or the start of an underlying disease. 90003 90002 Treatment depends on severity, and whether there is any bone damage.90003 90002 If there is no bone damage, treatment is similar to that used in acute osteomyelitis, but If there is bone damage, treatment will be similar to that used in chronic osteomyelitis. 90003 90012 Chronic osteomyelitis 90013 90002 In chronic osteomyelitis, infection starts at least 2 months after an injury, initial infection, or the start of an underlying disease. 90003 90002 Patients usually need both antibiotics and surgery to repair any bone damage. 90003 90002 Surgery can involve: 90003 90040 90041 90042 Draining: 90043 The area around the infected bone may need opening up for the surgeon to drain any pus or fluid that has built up in response to the infection.90044 90041 90042 Debridement: 90043 The surgeon removes as much diseased bone as possible, and takes a small margin of healthy bone to ensure that all the infected areas are removed. Any surrounding tissue with signs of infection may also need removing. 90044 90041 90042 Restoring blood flow to the bone: 90043 Any empty space left by debridement may have to be filled with a piece of bone tissue, or skin or muscle from another part of the body. Temporary fillers can be used until the patient is healthy enough for a bone or tissue graft.The graft helps the body repair damaged blood vessels, and it will form new bone. 90044 90041 90042 Removal of foreign objects: 90043 If necessary, foreign objects placed during previous surgery may be removed, such as surgical plates or screws. 90044 90041 90042 Stabilizing the affected bone: 90043 Metal plates, rods, or screws may be inserted into the bone to stabilize the affected bone and the new graft. This may be done later. Occasionally external fixators are used to stabilize the affected bone.90044 90061 90002 If the patient can not tolerate surgery, for example, because of illness, the doctor may use antibiotics for longer, possibly years, to suppress the infection. If the infection continues regardless, it may be necessary to amputate all or part of the infected limb. 90003 90002 The signs and symptoms of osteomyelitis depend on the type. 90003 90002 They commonly include: 90003 90040 90041 Pain, which can be severe, and swelling, redness, and tenderness in the affected area 90044 90041 Irritability, lethargy, or fatigue 90044 90041 Fever, chills, and sweating 90044 90041 Drainage from an open wound near the infection site or through the skin 90044 90061 90002 Other symptoms may include swelling of the ankles, feet, and legs, and changes in walking pattern, for example, a limp.90003 90002 The symptoms of chronic osteomyelitis are not always not obvious, or they could resemble the symptoms of an injury. 90003 90002 This can make accurate diagnosis more difficult, especially in the hip, pelvis, or spine. 90003 90012 Osteomyelitis in children and adults 90013 90002 In children, osteomyelitis tends to be acute, and it usually appears within 2 weeks of a pre-existing blood infection. This is known as hematogenous osteomyelitis, and it is normally due to methicillin-resistant 90087 Staphylococcus aureus (S.aureus) 90088 (MRSA). 90003 90002 Diagnosis can be difficult, but it is important to get a diagnosis as soon as possible, because delaying diagnosis can lead to growth disturbances or deformity. It can be fatal. 90003 90002 In adults, sub-acute or chronic osteomyelitis are more common, especially after an injury or trauma, such as a fractured bone. This is known as contiguous osteomyelitis. It usually affects adults over the age of 50 years. 90003 90002 Osteomyelitis can occur when a bacterial or fungal infection develops within a bone or reaches the bone from another part of the body.90003 90002 When an infection develops inside the bone, the immune system will try to kill it. Neutrophils, a type of white blood cell, will be sent to the source of the infection to kill the bacteria or fungus. 90003 90002 If the infection takes hold and is not treated, dead neutrophils will accumulate inside the bone, forming an abscess, or pocket of pus. 90003 90002 The abscess may block vital blood supplies to the affected bone. In chronic osteomyelitis, the bone may eventually die.90003 90002 Bones are normally resistant to infection, but infection may enter a bone under certain conditions. 90003 90002 An infection in the bloodstream, complications of trauma or surgery, or pre-existing conditions, such as diabetes, reduce the person’s ability to resist infection. 90003 90012 How bone infections start 90013 90002 Bone infections can occur in different ways. 90003 90002 In hematogenous osteomyelitis, the infection may start as a mild upper respiratory or urinary tract infection, for example, and travel through the bloodstream.This type is more common in children. 90003 90002 Post-traumatic osteomyelitis may occur after a compound fracture, a broken bone that breaks the skin, an open wound to surrounding skin and muscle, or after surgery, especially if metal pins, screws or plates are used to secure broken bones. 90003 90002 Vascular deficiency, or poor blood circulation, can cause infection to develop from a minor scrape or cut, usually on the feet. Poor circulation prevents white blood cells from reaching the site, leading to deep ulcers.These expose the bone and deep tissue to infection. 90003 90002 Vertebral osteomyelitis occurs in the spine. It usually starts with an infection in the bloodstream, a urinary or respiratory tract infection, endocarditis, which is an infection in the inner-lining of the heart, or an infection in the mouth or at an injection site. 90003 90012 Osteomyelitis of the jaw 90013 90002 Osteomyelitis of the jaw can be intensely painful, and it can result from caries or periodontal disease. The jawbone is unusual because the teeth provide a direct entry point for infection.90003 90002 Malignancy, radiation therapy, osteoporosis, and Paget’s disease increase a person’s risk of osteomyelitis of the jaw. 90003 90002 A sinus, gum, or tooth infection can spread to the skull. 90003 90002 Successful treatment of the infection is normally possible, but sometimes complications occur. 90003 90002 Chronic osteomyelitis can appear to have gone, but then it resurfaces, or it may persist undetected for years. This can lead to bone tissue death and the collapse of the bone.90003 90002 People with conditions that are difficult to treat, such as severe diabetes, HIV, poor circulation, or a weakened immune system are more at risk. 90003 90002 Some people are more likely to experience osteomyelitis. 90003 90002 People at higher risk may have: 90003 90040 90041 A weakened immune system, due, for example, to chemotherapy or radiation treatment, malnutrition, dialysis, having a urinary catheter, injecting illegal drugs, and so on 90044 90041 Circulatory problems, as a result of diabetes, peripheral arterial disease, or sickle cell disease 90044 90041 A deep puncture wound or a fracture that breaks the skin 90044 90041 Surgery to replace or repair bones 90044 90061 90002 Acute osteomyelitis is more common in children, while the spinal form is more common in patients aged over 50 years, and it is more common in males.90003 90002 The physician will examine the affected body part for signs of osteomyelitis, including tenderness and swelling. They will ask about recent medical history, especially any recent accidents, operations, or infections. 90003 90002 Tests may include: 90003 90040 90041 90042 Blood tests: 90043 High levels of white blood cells usually indicate infection. 90044 90041 90042 Biopsy: 90043 The physician takes a small piece of tissue to test which type of pathogen — bacteria or fungi — is causing bone infection.This helps find a suitable treatment. 90044 90041 90042 Imaging tests: 90043 An x-ray, MRI, or CT scan can reveal any bone damage. 90044 90061 90002 The damage may not be visible for 2 weeks on an X-ray, so more detailed MRI or CT scans are recommended if the injury is recent. 90003 90002 Patients with a weakened immune system should: 90003 90040 90041 Have a well-balanced healthy diet and suitable exercise, to boost the immune system 90044 90041 Avoid smoking, as this weakens the immune system and contributes to poor circulation 90044 90041 Practice good hygiene , including regular and proper handwashing 90044 90041 Have all the recommended shots 90044 90061 90002 Patients with poor circulation should: 90003 90040 90041 Avoid smoking, as it worsens the circulation 90044 90041 Maintain a healthy body weight by following a healthy diet 90044 90041 Exercise regularly to improve your circulation 90044 90041 Avoid excessive regular alcohol consumption as this raises the risk of hypertension, or high blood pressure, and high cholesterol 90044 90061 90002 People who are susceptible to infections should be especially careful to avoid cuts and scrapes.Any cuts or scrapes should be cleaned at once, and a clean dressing put over it. 90003 90002 Wounds need frequent checking for signs of infection. 90003.90000 Osteomyelitis of the jaw | Symptoms and Treatment of Jaw Osteomyelitis 90001 90002 Classification of jaw osteomyelitis 90003 90004 90005 [13], [14], [15] 90006 90007 Traumatic osteomyelitis 90008 90004 A disease that occurs as a result of jaw injuries or fractures. The traumatized site opens the virus to the bone, but the percentage of complications of this type is small. 90006 90004 A variety of osteomyelitis disease of the jaw refers to complications resulting from a fracture of the facial bone.Most often this happens with the lower jaw, but there are also single cases of damage to the upper jaw. Trauma to the bone opens the passageway for infection, which, under favorable conditions for it, begins to develop even further away from the zone of the fracture. 90006 90004 Therefore, if it has already happened that the jaw is injured, everything must be done to prevent the pathogenic flora from getting into the wound. 90006 90007 Osteomyelitis of the jaw after tooth extraction 90008 90004 Everything in our body is interconnected.Closed by a single innervation and the upper from the lower jaw, being the processes of the triadic nerve (responsible for the sensitivity of the nerve endings of the face). When the dentist is forced to wring out a sick tooth, it also removes the dental nerve, while the nerve endings of the gum and periodontal remain and are irritated due to pain after tooth loss (pain can be felt for up to a week). 90006 90004 If the pain does not pass a longer period of time, it is necessary to urgently consult a dentist in order not to miss the development of osteomyelitis.90006 90007 Hematogenous osteomyelitis 90008 90004 It is caused by inflammation that has arisen as a result of tissue damage caused by infection brought about by the flow of blood. Plasma, with its current through the vessels, seizes the infection in the inflamed foci and spreads it throughout the body. This type of disease, most often, develops on the basis of a chronic disease, or a long-term focus of infection. In this case, the inflammatory process goes as if in reverse order: the jaw bone first of all, and then the tooth can be defeated.This type of development of the disease is less common. 90006 90007 Radial osteomyelitis of the jaw 90008 90004 Malignant tumor of maxillofacial area. This diagnosis is not so rare in our time. The doctors have successfully learned to fight this disease. But his insidiousness lies not only in the possibility of returning the disease with the degeneration of cells into cancerous, but also the consequences that a patient has after receiving chemotherapy and radiotherapy. 90006 90004 Radial osteomyelitis of the jaw is a consequence of obtaining, in the course of treatment, a large dose of radiation and getting into the focus of the purulent pathogenic infection.The combination of these negative factors leads to the onset of purulent-necrotic processes in the jaw. The probability of the appearance of this lesion largely depends on the stability of the bone tissue to the ionizing radiation directed to it and the negative flora present or absent. That is, everything depends on the possibility of the body, its immune system, to resist the harmful effects from the outside. 90006 90004 More often, the causes of post-radial osteomyelitis of the jaw are considered by physicians to be trauma (physical and radiant energy) and infection.Clinical manifestations of the acquired disease — a slow gradual destruction of bone tissue, accompanied by severe pain, with the subsequent appearance of fistula, sequestration. If the patient does not provide medical assistance in time, the consequences can be deplorable. The bone is destroyed so much that there may be pathological fractures of the jaw. 90006 90007 Odontogenic osteomyelitis of jaws 90008 90004 The most common form of manifestation of the osteomyelitis of the jaw, resulting from serious complications in dental disease (for example, neglected tooth caries).Today, this type of ostiomyitis is diagnosed in more than half of the cases. The disease begins to gain momentum after getting the infection through the carious tissues in the pulp and then to the dental root. After the damage to the root of the tooth, the infection also grabs the nearby jaw tissue. About 70% of lesions belong to the lower jaw. The main damaging bacteria causing this type of disease are both streptococci and staphylococci, and anaerobic bacteria. These pathogenic microorganisms enter the maxillary tissue along the bony ducts, as well as the lymphatic system.90006 90004 The most common form of osteomyelitis of the jaw is its odontogenic variety, and it is affected by both adults and children of different ages. The cause of its occurrence is an infection that affects the carious tooth. And if you do not promptly seek help from a dentist who removes dead skin, cleans the dental canal and puts a seal, the pathogenic flora in the mouth will trigger the development of inflammation and the formation of a purulent capsule in the jaw bone, which leads to development of odontogenic osteomyelitis of the jaws.90006 90004 The anatomical features of the jaw are incomparable to any other area of ​​the human body. Due to the teeth, it is in this area that the bone closes as close as possible to the possible source of infection (oral cavity) and a sufficiently small breakdown (caries), so that the virus penetrates to the bone tissue. There is a violation of microcirculation of all processes, the necessary substances and microelements do not enter the tissue, partial cell death begins. 90006 90004 In the inflamed foci an abscess is formed, provoked by the work of such microorganisms as white or golden staphylococcus, streptococcus and others.Adaptation to drugs and mutations produce a fairly large range of anaerobic flora. This problem can manifest itself in a fuzzy clinic of the disease, in the atypical reaction of a person to medicines and in the manifestation of immunodeficiency. 90006 90004 Classify and the stage of the disease: subacute, acute and chronic. 90006 90004 The acute form of the osteomyelitis of the jaw is the response of the human body to the penetration of infection into it. Symptoms of this stage are akin to many other diseases, but there are differences: 90006 90047 90048 The patient feels weakness and malaise.90049 90048 Attacks of a headache begin. 90049 90048 There are problems with sleep. 90049 90048 There is an increase in temperature. 90049 90048 Disappears appetite. The patient is difficult to eat, as chewing food is accompanied by painful sensations. 90049 90048 The mucosa of the oral cavity begins to gradually blush. 90049 90048 Infection beats the immune and metabolic system — this is manifested by an increase in lymph nodes. 90049 90048 Teeth adjacent to the focus of infection become mobile.90049 90064 90004 When making a diagnosis, treatment should be started immediately. This stage of the disease is dangerous not only the course of the disease, but also its complications. Especially with this, the spleen and liver suffer. 90006 90004 If the treatment started on time and was maintained at the proper level, the disease goes to another stage — subacute osteomyelitis. At this stage, there are several other manifestations of the disease: 90006 90047 90048 Fistulas and dead skin patches form in the area of ​​bone tissue damage.At this stage there is a partial outflow of pus and fluid — this dulls the severity of the manifestation of symptoms. It seems to the patient that the disease is receding, but the inflammation is gaining momentum, the danger to the body is increasing. 90049 90064 90004 Later, the disease becomes chronic. This stage of the osteomyelitis of the jaw is most dangerous: 90006 90047 90048 For some time the patient feels almost healthy. But the disease does not slumber, and remission turns into a new exacerbation of osteomyelitis.There are sequestrants, new fistulas are formed. 90049 90064 90002 Osteomyelitis of lower jaw 90003 90004 This disease is the most often diagnosed by doctors in the localization of osteomyelitis in the jaw area. The development of the disease, often occurs due to the ingress through the lymphocytes and bone channels of the pathogenic flora to the bone tissue of the lower jaw. Another way to hit is through the pulp of the damaged tooth. 90006 90004 One of the first manifesting symptoms with it is a decrease in the sensitivity of the receptors of the nerve endings of the lower lip and chin.Significantly increases the sensitivity of the patient’s tooth. The pain of touching becomes more acute, pulsating. This all refers to the odontogenic form of the disease. 90006 90004 But the cause that can cause the development of osteomyelitis can be and trauma of the jaw zone, as well as its fracture — these root causes give impetus to the development of traumatic form. 90006 90004 And the third type of disease is hematogenous. Infection gets to the focus of inflammation through the blood.The cause of infection of blood can be a simple injection, or a blood transfusion. 90006 90004 For osteomyelitis of the lower jaw, all the manifestations observed with purulent fever are present. There is a general intoxication of the body, there is a chill (especially in the evening), breathing and pulse becomes rapid. At an acute stage of illness, temperature sharply jumps, sometimes approaching critical indicators in 40оС. Painful sensations seem to creep away, grabbing an ever larger area: discomfort increases with chewing, it becomes difficult to swallow.90006 90004 The severity of this disease is divided into: light, medium and heavy. Distinguish the same, in size, involved in the inflammatory process of the area: diffuse and limited. And as the division goes to the osteomyelitis of the jaw, passed without complications and a disease that entailed significant complications. 90006 90007 Odontogenic osteomyelitis of lower jaw 90008 90004 Odontogenic variety of this disease, according to medical observations is much more common than all the others.The lion’s share of all cases falls on the odontogenic osteomyelitis of the lower jaw. The disease is caused by a bacterial pathogenic flora that enters the area of ​​pulp and periodontal on the affected canal (tooth channel damage, caries and other tooth integrity disorders), provoking foci of inflammation. 90006 90004 Recently, more and more often pathogens of bone inflammation are obligate-anaerobic flora, up to a certain time, such bacteria as white and golden staphylococci, streptococci, varieties of rod-shaped bacteria prevailed… 90006 90004 But for the development of inflammation, there is not enough of a penetrating infection. The presence of other factors is also necessary: ​​a reduced, for whatever reason, immunity of the patient and, a high degree of ability of this infectious strain of a microorganism or a virus to infect the body. In small children, in connection with a still quite imperfect system of body protection, scales are inclined, more often, towards illness. 90006 90007 Traumatic osteomyelitis of lower jaw 90008 90004 It often occurs when injuries or trauma caused a fracture of the lower jaw (with the same damage to the upper jaw, such effects do not occur often).Not every inflammatory process after damage to bone tissue can lead to osteomyelitis of the jaw. If the process of inflammation is localized only in the zone of primary damage and does not spread to peripheral zones, it can be classified as focal abscess on the bone. With adequate treatment, started on the nascent stage of the disease, this process is stopped quickly enough and does not degenerate into the dying of bone tissue. 90006 90004 Any fracture does not manifest itself. In parallel with him, the patient gets soft tissue damage, a severe bruise.It does not dispense with hemorrhages, which form hematomas. This is a good time for the introduction of the virus and the further growth of phlegmon, or the appearance of an abscess. If timely sanation and open an abscess, support the patient with general restorative therapy, you can in a short time to stop the spread of the inflammatory process, not leading to necrotic manifestations. If the patient receives inadequate treatment or does not receive it at all, then the development of osteomyelitis is very great.90006 90004 The main cause of traumatic osteomyelitis of the lower jaw is a violation of metabolic processes and microcirculation necessary for the normal functioning of the body. The development of this disease is facilitated, first of all, by the patient’s later referral to the doctor, or untimely and incorrect treatment, as well as the concomitant other serious illnesses and non-compliance of patients with oral hygiene. 90006 90002 Osteomyelitis of the upper jaw 90003 90004 Osteomyelitis of the upper jaw, according to medical observations, is much less common, but there are still cases of this disease, so consider this case.90006 90004 Medicine considers several ways of penetrating an infection that affects the upper jaw. 90006 90047 90048 Hematogenous pathway. Hit the pathogenic flora through the plasma. This can happen with the help of an ordinary injection, as well as in the case of blood transfusions (the virus can be entered with blood if the blood itself was infected, or sterility was violated during the procedure). 90049 90048 The lymphogenous path. Influx of infection through the lymph system. 90049 90048 Contact or rhinogenic.Penetration comes from the mouth. It can be an inflammatory process that seizes the mucous membrane of the maxillary sinuses (this can happen in chronic or acute rhinitis), as well as the penetration of the pathogenic flora along the gland ducts through the periosteum. 90049 90048 A newborn can «catch» this disease during labor during the application of forceps, or through infected maternal genitalia. It can happen during feeding, through the nipples (if the mother is suffering from mastitis).Not observing the general hygiene for the baby is fraught with the penetration of infection from dirty toys or nipples, especially during the period when the teeth begin to be cut. 90049 90064 90004 Especially dangerous is the osteomyelitis of the jaw for babies, as the disease develops rapidly and the main thing is not to miss the time, quickly and correctly diagnose, immediately begin treatment. In this category of patients, this disease is more often manifested as an abscess on the basis of sepsis, less often — sepsis develops on the basis of acute RVI (respiratory viral infection).90006 90004 The main symptoms of the disease, which are the same for both young children and adults, with the only difference that in infants these processes occur more rapidly and with pronounced manifestations: 90006 90047 90048 This disease in children begins suddenly. Sharply rising the temperature to 39 ÷ 40 90131 on the 90132 S. 90049 90048 The kid is naughty, does not want to eat. 90049 90048 There is an edema in the nose-cheek-eye area. 90049 90048 During the first day the eye gap is completely closed, the upper lip becomes insensitive, the nasolabial fold disappears.Lichiko becomes asymmetrical, as if skewed. 90049 90048 The lymph nodes in the size of the viral lesion increase in size. 90049 90048 Over the next three days, puffiness not only seizes the face, but also the neck. 90049 90048 The process is developing (in children in the dentition, in adults in the root system of the tooth) suppuration. And there is a rejection of sequestration. 90049 90048 Due to the edema, the nasal passage narrows or overlaps, which prevents normal breathing. Gradually, it begins to fill with purulent secretions.90049 90048 Already in the first — the second day after infection, the skin in the area of ​​swelling acquires a pink shade with a shiny texture. When touching — a sharp pain. 90049 90048 Already on the first day on the alveolar bone, local infiltrates may appear. The mucous membrane becomes hyperemic, softened (bone tissue begins to break down) and increases in size. There is a fluctuation. 90049 90048 Approximately on the fifth day, a certain amount of sequestration is detected, beginning to appear in the nasal cavity of the fistula.They are formed in the sky, in the area of ​​the inner corner of the eye, in the region of dental rudiments. The upper jaw becomes pathologically mobile. 90049 90048 Fast enough inflammation and eye sockets. The abscess of the eyelids begins. Any movement causes pain. The eyeball becomes motionless — the phlegm of the orbit develops. 90049 90064 90004 The consequences of complications in osteomyelitis of the upper jaw can be terrible, especially for babies. This and meningitis, sepsis, phlegmon orbits, pneumonia, abscess of the lung and brain, purulent pleurisy… 90006 90002 Acute osteomyelitis of the jaw 90003 90004 Physicians refer to this disease as nonspecific infectious inflammatory diseases. It has a number of characteristic symptoms, some can be both obligate and optional (that is, such symptoms can manifest, or may not be observed). 90006 90004 The organism reacts to the penetration of infection in this phase as follows: 90006 90047 90048 Decreased vitality. 90049 90048 Pain in the head area. 90049 90048 There is a chill. 90049 90048 The temperature can be fixed at 37 ÷ 37.5 ° C or reach 40 ° C (this applies more to children). 90049 90048 Heart palpitation is increasing. 90049 90048 Intoxication of the body. 90049 90048 Reduced blood pressure. 90049 90048 From the mouth cavity is quite unpleasant smell. 90049 90048 Mucous membrane is hyperemic, noticeable edema is observed. 90049 90048 When touching — strong pain. 90049 90048 There is an outflow of purulent masses from under the gums. 90049 90048 There may be abnormal mobility of teeth in the area of ​​inflammation.90049 90064 90004 The patient’s condition at this stage is light, medium and heavy. Proceeding from this, the doctors prescribe therapeutic measures corresponding to this condition. • 90006 90047 90048 There is numbness of tissues, their sensitivity is disturbed. 90049 90048 Blood tests show that the body is undergoing an inflammatory process. 90049 90048 Enlarged lymph nodes. They become painful when touched. 90049 90048 After removal and dissection of the tooth (the first day), pus is intensifying.Improvement of the patient’s condition is not observed. 90049 90048 Only on the second day the patient becomes easier, the inflammation subsides, the amount of pus coming out decreases. 90049 90064 90004 90005 [16], [17], [18], [19], [20], [21] 90006 90007 Acute odontogenic osteomyelitis of the jaws 90008 90004 An infection-purulent lesion of the jaw bones, the source of which is a virus or infection, which penetrated into the inflammation focus due to tooth decay, followed by its complication.Infection affects the contact, with further expansion of the affected area and the formation of osteonecrosis (the gradual withering of bone matter). 90006 90004 In fact, acute odontogenic osteomyelitis of the jaws is nothing more than a complication that has appeared with the advanced stage of caries. 90006 90004 90005 [22], [23], [24], [25], [26] 90006 90007 Acute osteomyelitis of lower jaw 90008 90004 As it was already said above, this disease most often affects the lower jaw. The doctor diagnoses the patient on the basis of a comprehensive examination.Primarily, this is based on a patient complaint and a visual examination by a specialist. Next, «connect» radiography and laboratory tests. 90006 90004 The main symptoms in acute form are identical, be it traumatic, odontogenic or hematogenous osteomyelitis. The common thing about them is that you should not start the disease and expect the process to «resolve» itself. The earlier a patient begins to provide medical care, the more sparing the therapy will be and the less destructive effects of inflammation on the body.90006 90004 90005 [27], [28], [29], [30] 90006 90007 Acute odontogenic osteomyelitis of lower jaw 90008 90004 It is this kind of disease, as it is not strange, is found most often. Have you started your teeth and are afraid to go to the doctor? Your cowardice can cause illness. Carefully read the symptoms of the disease. Maybe this will help you to visit the dentist. 90006 90004 90005 [31] 90006 90002 Chronic osteomyelitis of the jaw 90003 90004 The chronic form of this disease is unpleasant not only with the symptomatology, but also with the fact that the disease can proceed with varying success (sometimes fading, but again exacerbating) for several months.There is a periodic appearance of new fistulas and rejection of necrotic areas of bone tissue. The chronic form requires periodic observation by a specialist. 90006 90004 90005 [32], [33], [34], [35], [36] 90006 90007 Chronic osteomyelitis of lower jaw 90008 90004 The chronic form of the disease is more often noted by the end of 4 weeks, when a sequester is formed, fistulas appear. Patient’s state of health is consistently satisfactory. Normalized temperature and protein levels in the blood.90006 90004 The main reason for the transition from an acute form to a chronic doctor is considered untimely arrest of the acute stage of the disease (tooth extraction …). 90006 90004 90005 [37], [38], [39] 90006 90007 Chronic odontogenic osteomyelitis of the jaws 90008 90004 Most often, chronic odontogenic osteomyelitis of the jaws affects children 3 to 12 years (period of incision and replacement of teeth), as well as adults whose mouth, for the most part, is not sanitized. 90006 90004 90005 [40], [41], [42], [43] 90006 .90000 Osteomyelitis — Symptoms and causes 90001 90002 Overview 90003 90004 Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. 90005 90004 Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.90005 90004 Although once considered incurable, osteomyelitis can now be successfully treated. Most people need surgery to remove areas of the bone that have died. After surgery, strong intravenous antibiotics are typically needed. 90005 90010 Products & Services 90011 Show more products from Mayo Clinic 90002 Symptoms 90003 90004 Signs and symptoms of osteomyelitis include: 90005 90016 90017 Fever 90018 90017 Swelling, warmth and redness over the area of ​​the infection 90018 90017 Pain in the area of ​​the infection 90018 90017 Fatigue 90018 90025 90004 Sometimes osteomyelitis causes no signs and symptoms or the signs and symptoms are hard to distinguish from other problems.This may be especially true for infants, older adults and people whose immune systems are compromised. 90005 90010 When to see a doctor 90011 90004 See your doctor if you experience worsening bone pain along with fever. If you’re at risk of infection because of a medical condition or recent surgery or injury, see your doctor right away if you notice signs and symptoms of an infection. 90005 90002 Causes 90003 90004 Most cases of osteomyelitis are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.90005 90004 Germs can enter a bone in a variety of ways, including: 90005 90016 90017 90040 The bloodstream. 90041 Germs in other parts of your body — for example, in the lungs from pneumonia or in the bladder from a urinary tract infection — can travel through your bloodstream to a weakened spot in a bone. 90018 90017 90040 Injuries. 90041 Severe puncture wounds can carry germs deep inside your body. If such an injury becomes infected, the germs can spread into a nearby bone.Germs can also enter the body if you have broken a bone so severely that part of it is sticking out through your skin. 90018 90017 90040 Surgery. 90041 Direct contamination with germs can occur during surgeries to replace joints or repair fractures. 90018 90025 90002 Risk factors 90003 90004 Your bones are normally resistant to infection, but this protection lessens as you get older. Other factors that can make your bones more vulnerable to osteomyelitis may include: 90005 90010 Recent injury or orthopedic surgery 90011 90004 A severe bone fracture or a deep puncture wound gives bacteria a route to enter your bone or nearby tissue.A deep puncture wound, such as an animal bite or a nail piercing through a shoe, can also provide a pathway for infection. 90005 90004 Surgery to repair broken bones or replace worn joints also can accidentally open a path for germs to enter a bone. Implanted orthopedic hardware is a risk factor for infection. 90005 90010 Circulation disorders 90011 90004 When blood vessels are damaged or blocked, your body has trouble distributing the infection-fighting cells needed to keep a small infection from growing larger.What begins as a small cut can progress to a deep ulcer that may expose deep tissue and bone to infection. 90005 90004 Diseases that impair blood circulation include: 90005 90016 90017 Poorly controlled diabetes 90018 90017 Peripheral artery disease, often related to smoking 90018 90017 Sickle cell disease 90018 90025 90010 Problems requiring intravenous lines or catheters 90011 90004 There are a number of conditions that require the use of medical tubing to connect the outside world with your internal organs.However, this tubing can also serve as a way for germs to get into your body, increasing your risk of an infection in general, which can lead to osteomyelitis. 90005 90004 Examples of when this type of tubing might be used include: 90005 90016 90017 Dialysis machine tubing 90018 90017 Urinary catheters 90018 90017 Long-term intravenous tubing, sometimes called central lines 90018 90025 90010 Conditions that impair the immune system 90011 90004 If your immune system is affected by a medical condition or medication, you have a greater risk of osteomyelitis.Factors that may suppress your immune system include: 90005 90016 90017 Cancer treatment 90018 90017 Poorly controlled diabetes 90018 90017 Needing to take corticosteroids or drugs called tumor necrosis factor inhibitors 90018 90025 90010 Illicit drugs 90011 90004 People who inject illegal drugs are more likely to develop osteomyelitis because they may use nonsterile needles and are less likely to sterilize their skin before injections. 90005 90002 Complications 90003 90004 Osteomyelitis complications may include: 90005 90016 90017 90040 Bone death (osteonecrosis).90041 An infection in your bone can impede blood circulation within the bone, leading to bone death. Areas where bone has died need to be surgically removed for antibiotics to be effective. 90018 90017 90040 Septic arthritis. 90041 Sometimes, infection within bones can spread into a nearby joint. 90018 90017 90040 Impaired growth. 90041 Normal growth in bones or joints in children may be affected if osteomyelitis occurs in the softer areas, called growth plates, at either end of the long bones of the arms and legs.90018 90017 90040 Skin cancer. 90041 If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer. 90018 90025 90002 Prevention 90003 90004 If you’ve been told that you have an increased risk of infection, talk to your doctor about ways to prevent infections from occurring. Reducing your risk of infection will also help your risk of developing osteomyelitis. 90005 90004 In general, take precautions to avoid cuts, scrapes and animal scratches or bites, which give germs easy access to your body.If you or your child has a minor injury, clean the area immediately and apply a clean bandage. Check wounds frequently for signs of infection. 90005 90134 90004 Nov. 16, 2018 90005.90000 Pathology Outlines — Osteomyelitis overview 90001 90002 Mandible & maxilla 90003 90002 Osteomyelitis and inflammatory conditions 90003 90002 Osteomyelitis overview 90003 90008 90009 90010 90002 90012 Topic Completed: 90013 1 July 2014 90003 90002 90012 Minor changes: 90013 8 July 2020 90003 90008 90020 Copyright: 90021 2004-2020, PathologyOutlines.com , Inc. 90002 90020 PubMed Search: 90021 Osteomyelitis [title] mandible maxilla 90003 90008 90009 90010 90002 90012 Page views in 2019: 90013 1,461 90003 90002 90012 Page views in 2020 to date: 90013 866 90003 90002 90012 Cite this page: 90013 Morrison A.Osteomyelitis overview. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillaosteomyelitis.html. Accessed July 11th, 2020. 90003 90002 Definition / general 90003 90043 90044 Originates from Greek words osteon (bone) and muelinos (marrow) 90045 90044 While the original derivation emphasizes involvement of marrow, common medical literature extends the definition to an inflammation process of the entire bone including cortex and periosteum, recognizing that the pathological process is rarely confined to the medullary portion 90045 90044 Osteomyelitis has been used to encompass a wide variety of pathoses / etiologies, such as traumatic injuries, radiation, and certain chemical substances, but the term is mostly often used to describe infection of the bone 90043 90044 Osteomyelitis of the jaws is predominantly a disease of the mandible, because the maxilla is vascular with thin cortical plates and less frequently involved 90045 90044 When infection becomes established, pus or edema in the medullary cavity and beneath the periosteum can compromise the local blood supply 90043 90044 Ischemia can lead infected bone to become necrotic and sequester which is considered a classical sign of osteomyelitis 90045 90056 90045 90044 Osteomyelitis of the jaws is still fairly common in maxillofacial clinics and offices despite the introduction of antibiotics and the improvement of dental and medical care 90045 90056 90045 90044 Infection of the jaws, due to its unique feature bearing teeth and connecting to the oral cavity / oral environment with the periodontal membrane, differs in several important aspects from osteomyelitis of long bones 90043 90044 The specific local immunological and microbiological aspects determine a major factor in the etiology and pathogenesis of this disease and hence also have a direct impact on its treatment; therefore, to extrapolate from long bone infections to disease of the jaws has limitations 90045 90044 This is reflected by the longstanding recognition of osteomyelitis of jawbones as a clinical entity which differs in many important aspects from that in long bones; hence, a wide variety of classifications, specifically for the jawbones, have been established 90045 90044 Classifications are based on different aspects such as clinical course, pathological-anatomical or radiological features, etiology and pathogenesis 90045 90044 A mixture of these classification systems is often used, leading to confusion, hindering comparative studies and obscuring classification criteria 90045 90056 90045 90044 The Zurich system of osteomyelitis is generally accepted as the most reliable classification for osteomyelitis 90045 90044 Classification is primarily based on clinical course and imaging 90045 90056 90002 Terminology 90003 90043 90044 90020 Cortical bone 90021 90043 90044 Cortical bone, synonymous with compact bone, is one of the two types of osseous tissue that form bones 90045 90044 Forms the cortex, or outer shell, of most bones 90045 90044 Much denser than cancellous bone, the other type of osseous tissue; is also harder, stronger and stiffer than cancellous bone 90045 90056 90045 90044 90020 Medullary bone / medullary cavity / marrow cavity 90021 90043 90044 The medullary cavity (medulla, innermost part) of bone is the central cavity where red bone marrow or yellow bone marrow (adipose tissue) is stored; hence, the medullary cavity is also known as the marrow cavity 90045 90044 The medullary cavity has walls composed of spongy bone (cancellous bone) and is lined by endosteum which are osteoprogenitor cells 90045 90056 90045 90044 90020 Periosteum 90021 90043 90044 Connective tissue membrane lining the outer / external surface bones except at the joints of long bones 90045 90044 Is composed of an outer fibrous layer and an inner cambium / osteogenic layer 90045 90056 90045 90044 90020 Periapical granuloma 90021 90043 90044 Acute or chronic inflammation admixed with fibrous or granulation tissue l 90045 90056 90045 90056.