Osteomyelitis of the Jaw

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Osteomyelitis is an infection involving all layers of bone in which widespread necrosis may occur. It  is rare in the maxilla due to the rich blood supply, but on occasions may affect the anterior palate  where the bone is thicker. It is more common in the mandible, usually because of dental infection,  trauma, or a blood-borne infection. 

Clinical presentation 

  • In the initial stage there is no swelling
  • Malaise and fever
  • Enlargement of regional lymph nodes
  • Teeth in the affected area become painful and loose
  • Later as the bone undergoes necrosis the area becomes very painful and swollen
  • Pus ruptures through the periosteum and discharged outside the skin surface through a sinus

Investigation 

X-ray – OPG (Orthopantomography) or mandibular lateral oblique, water’s view for maxilla/midface. The  x-ray  will  show  sequestra  formation  in  chronic  stage.  In  early  stage,  features  seen  in  x-ray include widening of periodontal spaces, changes in bone trabeculation and areas of radiolucency. Perform culture and sensitivity of the pus aspirate to detect the specific bacteria.

Non-pharmacological Treatment  

  • Incision and adequate drainage to confirmed pus accumulation which is accessible. 
  • Removal of the sequestrum by surgical intervention (sequestrectomy) is done after the formation of  sequestrum has been confirmed by X-ray

Pharmacological Treatment 

For acute osteomyelitis of the jaw 

B: ampicillin + cloxacillin (FDC) (PO) 500mg 8hourly for 4-6weeks 

AND 

A: metronidazole (PO) 400mg 8hourly for 4-6weeks. If culture is available treat according to results. 

For chronic osteomyelitis of the jaw where sequestrectomy has been done 

A: doxycycline (PO) 100mg 12hourly for 5days 

OR 

A: metronidazole (PO) 400mg 8hourly for 5days 

AND 

S: clindamycin (PO) 500mg 8hourly for 5days