Acute osteomyelitis occurs more frequently in the mandible than in the maxilla. It starts with an infection of the cancellous or medullary portion of the bone, which usually enters by way of a wound or an opening through the cortical plate of bone (for example, the alveolar socket), admitting an infection into the central structure. This infection may enter as a result of a periapical or pericoronal infection prior to any surgical intervention, or it may be introduced through a needle puncture, particularly if pressure methods have been employed or interosseous anesthesia has been a method employed.
The infection may be localized, or it may diffuse through the entire medullary structure of the mandible or maxilla, and it may be preceded by an acute infection. It can be preceded by septic cellulitis, or it can follow what was apparently a simple extraction of an infected tooth.
The onset of an osteomyelitis is evidently associated with the lack of resistance of an individual patient to the particular organisms that invade the osseous structure. Prior to the advent of chemotherapeutic and antibiotic agents, osteomyelitic infection was not uncommon. It most frequently followed an invasion through a third molar wound. Since the employment of antibiotic therapy at the first sign of septic postoperative sequelae, osteomyelitis is rarely seen. On infrequent occasions, however, this disease still occurs, and the use of antibiotics has but little impeding effect on its progress.
Symptoms include a deep persisting pain, occasionally accompanied by intermittent paresthesia of the lip. An edema of the overlying soft tissues and an accompanying periostitis is usually present. The patient may ultimately experience malaise and an elevation in temperature. The condition may persist to a state at which the infection breaks through the cortical bone and invades the soft tissues, and induration followed by abscess formation becomes evident.
Since wide variations in radiographic evidence or clinical symptoms occur, early diagnosis sometimes is difficult. The osteomyelitic process originates within the cancellous structure of the bone, and destruction of the cancellous structure occurs with much less resistance than that of the cortical bone. The cortical bone is dense, and the destructive process may progress before it can be revealed in the radiograph because of the superimposition of the denser cortical bone. In the more aggressive or rampant types, destruction may occur rapidly and the cortical bone may be invaded so that radiographic evidence becomes visible at an early date. This destructive process has no definite pattern. A radiolucent area seen in the radiograph. is often described as having a wormy appearance.
In the invasive or rampant nonlocalized type, all teeth in the section of the mandible or maxilla may become mobile or tender, and pus may be observed around the necks of the teeth and interproximal spaces. Multiple perforating sinuses may be draining pus into the oral vestibule or burrowing into the overlying musculature and forming abscesses, which, if not incised and drained, will spontaneously rupture to the surface. If this latter condition is permitted, an ugly, indented scar results.
Treatment. The earlier a diagnosis can be made and definitive treatment started, the，英语论文范文，英语论文范文 |
