AtlasBoneOsteomyelitis of the Jaws

Bone Diseases

Osteomyelitis of the Jaws

Inflammation of medullary and cortical bone, most often of the mandible, secondary to odontogenic infection or trauma; classified as acute, chronic suppurative, chronic non-suppurative and specific forms.

Sequestrum
Dead necrotic bone
Involucrum
New periosteal bone
Rx
IV abx 4–6 wk + debride

§ overviewOverview

Inflammatory condition of bone that begins as an infection of the medullary cavity and Haversian systems, extending to the periosteum.

§ icdICD Classification

M86.9 / K10.2

§ etiologyEtiology

  • 01Odontogenic infection (majority)
  • 02Trauma, fracture
  • 03Radiation (ORN), MRONJ overlap
  • 04Haematogenous (rare in adults)

§ riskRisk Factors

  • 01Diabetes, immunosuppression, malnutrition
  • 02Smoking, alcohol
  • 03Sickle cell disease (mandible)
  • 04Reduced vascularity (radiation, bisphosphonates)

§ pathogenesisPathogenesis

Infection raises intramedullary pressure → vascular compromise → bone necrosis → sequestrum formation; periosteal new bone forms an involucrum with a cloaca discharging pus.

§ clinicalClinical Features

  • 01Acute: deep throbbing pain, swelling, fever, trismus, tender teeth, Vincent sign (paraesthesia of lower lip)
  • 02Chronic: recurrent swelling, sinuses, sequestra extruding through mucosa/skin

§ radiographicRadiographic Features

  • 01Early (10–14 d): ill-defined 'moth-eaten' radiolucency
  • 02Sequestrum (radiopaque island)
  • 03Involucrum (new bone)
  • 04Periosteal reaction (onion-skin in Garrè)

§ investigationsInvestigations

  • 01CT for cortical detail
  • 02MRI/bone scan for early marrow oedema
  • 03Bone biopsy and culture (aerobic + anaerobic)

§ classificationClassification

  • 01Acute suppurative
  • 02Chronic suppurative (secondary/primary)
  • 03Chronic non-suppurative (Garrè sclerosing/proliferative periostitis)
  • 04Diffuse sclerosing osteomyelitis (SAPHO / CRMO spectrum)
  • 05Specific: tuberculous, syphilitic, actinomycotic

§ treatmentTreatment

  • 01Culture-directed IV antibiotics — empirical: penicillin + metronidazole or clindamycin; continue 4–6 wk (longer for chronic)
  • 02Surgical: drainage, sequestrectomy, saucerisation, decortication
  • 03Resection with reconstruction for refractory cases
  • 04Hyperbaric oxygen for refractory/ORN
  • 05Control comorbidities (diabetes)

§ complicationsComplications

  • 01Pathological fracture
  • 02Systemic sepsis
  • 03Extraoral fistula
  • 04Malignant transformation (rare, chronic osteomyelitis)

§ prognosisPrognosis

Good for acute with prompt treatment; chronic forms may require multiple surgeries.

§ examKey Examination Points

  • 01Vincent sign in acute mandibular osteomyelitis
  • 02Sequestrum on plain film

§ revisionQuick Revision Summary

  • 01Sequestrum + involucrum · long IV antibiotics + surgical debridement

§ vivaBDS Viva Questions

  • 01Vincent sign?
  • 02Sequestrum vs involucrum?
  • 03Garrè osteomyelitis?

§ mcqsMCQs — Assessment (3)

Question 1

Vincent sign refers to:

Question 2

Radiographic hallmark of chronic osteomyelitis:

Question 3

Onion-skin periosteal reaction:

References

  1. Baltensperger MM. Osteomyelitis of the Jaws 2009

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.