osteomyelitis & osteoradionecrosis

OSTEOMYELITIS

Dr V.RAMKUMAR

CONSULTANT DENTAL&FACIOMAXILLARY SURGEON

REG NO:4118-TAMILNADU-INDIA(ASIA)

RECAP

- DEFINITION

- PERIOSTITIS/ OSTEITIS

- OSTEOMYELITIS- Classification- Etiology- Microbiology- Pathogenesis

Acute Osteomylitis – Clinical features

Local painful tooth (if Odontogenic )

Parasthesia of the lip (mandible )

Swelling in the effected area

Difficulty in mouth opening

General

raise In temperature

Rapid pulse & respiration

Nausea & vomiting

Dehydration,acidosis,albuminuria

leukocytosis

Radiographic Features Enlargement of the marrow space

Sequestrum (Dead bone surrounded by osteolytic

channels)

Involucrum (Reactive bone formation)

IN EARLY DETECTION OF OSTEOMYLITIS

SCINTIGRAPHY – BONE SCAN

CHRONIC OSTEOMYLITIS CLINICAL FEATURE

PAIN IN THE EFFECTED TOOTH

SWELLING

SINUS DISCHARGE ( EXTRA ORAL )

LESS SYSTEMIC SYMPTOMS

DIFFICULTY IN MOUTH OPENING

RADIOLOGICAL FEATURE CHRONIC OSTEOMYLITIS MORE OF RADIO OPAQUE

OR MIXED RADIO OPAQUE&RADIOLUCENT(CLASSICAL MOTH - EATTEN APPEARANCE)

PROTOCOL OF MANAGEMENT EMPERICAL ANTIBIOTIC

CONTROL OF TOXIC SYMPTOMS INCISION & DRAINAGE

CULTURE & SENSITIVITY APPROPRIATE ANTIBIOTICS

REMOVAL OF THE CAUSE LATERAL TRIPHINATION

CURRETAGE SEQUESTRECTOMY

SAUCERIZATION DECORTICATION

SEGMENTAL RESSECTION

HBO

I & D ONLY IF IT IS FLUCTUENT

SEND FOR CULTURE AND SENSITIVITY

CREATES A UNIFORM BED

HELPS IN COMPLETE DRAINAGE

IMPROVE THE BLOOD SUPPLY

SAUCERIZATION

IMPROVES BLOOD SUPPLY TO THE BONE

DECORTICATION

ANTIBIOTIC IRRIGATION

OSTEOMYLITIS IN CHILDREN

COMPLICATED BY PRESENCE OF TOOTH GERM

IN CONDYLE MAY LEAD TO TMJ ANKYLOSIS AND SECONDARY FACIAL

DEFORMITY

GARRES’ OSTEOMYLITISNON SUPPURATIVE TYPE

CARLE GARRE 1893 PELL 1955 - IN MANDIBLE

CHILDRENS AND YOUNG ADULT GENERALLY IN THE MANDIBLE

PHERIPHERAL SUB PERIOSTEAL BONE DEPOTISION - DUE TO MILD IRRITATION & INFECTION

RADIOGRAPHICALLY - OCCLUSAL VIEW - CORTICAL THICKENING

DD- INFANTILE CORTICAL HYPEROSTOSIS (CAFFEY’S DISEASES )

REMOVE THE CAUSE - WAIT & WATCH OCCATIONALLY - RECONTOURING IS PERFORMED

THICKENING OF THE OUTER CORTEX

REACTIVE BONE FORMATION

PERIOSTITIS

HYPER BARIC OXYGEN

ADJUVENT THERAPY100% OXYGEN UNDER PRESSURE

TO THE CHAMBER – DIVE

HYPOXIC HYPOCELLULAR

HYPOVASCULARITY taken care by H B O

90 mts DIVE – IN MONO PLACE CHAMBER

OSTEORADIONECROSISComplication after irradiation

IRRADIATION

TRAUMA

INFECTION

CLINICAL FEATURE

PAIN & SWELLING RADIATION CARIES

(DEMINERALIZATION OF THE TOOTH STRUCTURES)

MUCOSITISDECREASED SALIVARY SECREATIONS

SEQUESTRATION OF THE BONE CHRONIC SINUS DISCHARGE

SKIN INFECTION

PREVENTION PREPARE THE ORAL CAVITY FOR

IRRADIATION

MAINTAIN GOOD ORAL HYGEINE

EXTRACT ALL INFECTED AND NON VITAL TOOTH

EXTRACT PERIODONTALLY WEEK TOOTH

TOTAL EXTRACTION CAN BE PERFORMED IN CASE OF HEAVY IRRADIATION

PRE & POST IRRADIATION ANTI BIOTICS

FLOURIDE THERAPY TO PREVENT IRRADIATION CARIES

SUFFICIENT TIME FOR IRRADIATION AFTER EXTRACTION

PEVENTION IS THE CURE FOR ORN

MANAGEMENT OF ORN

PARENTRAL ANTIBIOTICS ( FLAGYL)

DEBRIDEMENT WITH H2O2 ( ANTIBIOTICS )

ANTIBIOTIC DRESSING

H B O

SURGICAL RESECTION OF THE AFFECTED PART

RESECTION & RECONSTRUCTION

RIM RESECTION / SEGMENTAL

INTRA ORAL / EXTRA ORAL

LA / GA

Osteoradionecrosis

THANK YOU