Osteomyelitis of the Jaw

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Description

This is an inflammation of the medullary portion of the jaw bone which extends to involve the periosteum of the affected area. The infection becomes established in the bone ending up with pus formation in the medullary cavity or beneath the periosteum obstructs the blood supply. The infected bone becomes necrotic following ischemia.

Signs and Symptoms

  • In the initial stage there is no
  • Malaise and fever
  • Enlargement of regional lymph nodes
  • Teeth in the affected area become painful and loose, thus causing difficulty in chewing
  • Later as the bone undergoes necrosis, the area becomes very painful and swollen
  • Pus ruptures through the periosteum into the muscular and subcutaneous fascia and eventually it is discharged on to the skin surface through a sinus

Investigations

  • X-ray – OPG (Orthopantomograph) 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 radioluscency.
  • Perform culture and sensitivity of the pus to detect the specific bacteria

Treatment

Supportive

  • 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

  • Amoxicillin 500mg 8 hourly for 10 days OR
  • Azithromycin 500mg (PO) once a day for 3 - 5days OR
  • Erythromycin 500mg (PO) 6 hourly for 5- 7 days AND
  • Metronidazole 400mg (PO) 8 hourly for 10 days
  • If culture is available, treat according to result.