What is jaw osteomyelitis?

Osteomyelitis is an inflammatory condition of bone that begins from an infection within the bone cavity. The infection is generally bacterial in origin and is most commonly caused by Staphylococcus aureus. Osteomyelitis can affect any bone in the body but has a predilection towards long bones and the jaw bones. Osteomyelitis affecting jaws is generally associated with dental complications. It was once a very serious disease with life threatening complication but these days it can be adequately treated with prompt medical intervention.

Jaw Osteomyelitis Symptoms

Osteomyelitis can be acute, subacute or chronic in nature. The acute form of osteomyelitis of the jaws generally affects the mandible, the lower jaw. Common symptoms include fever, malaise, nausea, vomiting and dehydration. The affected area of jaws is associated with continuous, intense and deep bony pain. The lower lip is associated with tingling sensations or loss of sensations.

Acute Jaw Osteomyelitis

Facial cellulitis and a hard swelling over the affected area develops in acute forms of the disease. The teeth become tender on percussion. Difficulty in jaw opening is often present. A pus discharge into the oral cavity and over the skin through an opening is present in established cases of osteomyelitis. It may also be associated with a fetid odor.

Chronic Jaw Osteomyelitis

The chronic forms of osteomyelitis present with pain and tenderness over the affected area. Pain is minimal in such cases. It may also be associated with bony and overlying soft tissue wounds with firm to hard consistency. In chronic osteomyelitis the bone has a thickened, woody characteristic appearance. The teeth present in the region of the infection often become loose.

Jaw Osteomyelitis Causes

Acute osteomyelitis of the jaws is caused by pyogenic organisms. The chronic form occur secondary to untreated or incompletely treated acute infections. The commonly involved bacteria are Staphylococcus aureus but Streptococcus pyogenes and Spirochetes are also responsible.

The most common causes of infections are as follows :

• Dental infections including dental abscess ,periodontal disease, pericoronitis and infected cysts and tumor.
• Local traumatic injuries.
• Peritonsillar abscess (quinsy).
• Furuncle of skin.
• Blood borne infections.

Risk Factors

The risk factors for developing osteomyelitis are :

• Lowered immunity.
• Malnourished children.
• Systemic disease including diabetes and leukemia.
• Acute illnesses such as influenza, scarlet fever and pneumonia.
• Radiation to the head and neck.

Treatment of Jaw Osteomyelitis

The treatment includes antibiotic therapy, supportive masures, complete bed rest and surgery if necessary.

• Antibiotics that are generally prescribed include penicillins, penicillinase-resistant penicillins, clindamycin, cephalosporins, metronidazole and erythromycins.
• In acute forms of the disease analgesics or sedation may be given to reduce the pain.
• Intravenous fluids are administered to avoid dehydration.
• Blood transfusions may be required in cases with low hemoglobin levels.
• High protein diet and nutritional support is also recommended.
• Hyperbaric oxygen therapy is also very useful in treating osteomyelitis. It involves intermittent inhalation of 100% oxygen, humidified under pressure.

Surgery

Surgical procedures include :

• extraction of the offending tooth
• incision and drainage of an existing abscess

The infected portion of the bone can be surgically removed or entire segment of the jaw can be excised according to the extent of the disease. Immediate or delayed jaw reconstruction is carried out subsequently.

References :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884909/