NEET MDS Lessons
Oral Pathology
Acute suppurative osteomyelitis
- Serious sequela of periapical infection.
- Leads to spread of pus through the medullary cavities of bone.
- Depending upon the main site of involvement of bone, can be of two types-
- Acute intramedullary
- Acute subperiosteal
Acute Intramedullary Osteomyelitis
CLINICAL FEATURES:
- Patient experiences dull , continuous pain , indurated swelling forms over the affected region of jaw involving the cheek , febrile.
- When mandible involved, loss of sensation occurs on lower lip on affected side due to involvement of inferior alveolar nerve.
- Teeth become loose later along with tender on percussion
- Pus discharge , trismus , foul smell , regional lymphadenopathy , weakness
RADIOGRAPHIC FEATURES
- Earliest radiographic change is that trabeculae in involved area are thin, of poor density & slightly blurred.
- Subsequently multiple radiolucencies appear which become apparent on radiograph.
- In some cases there is saucer shaped area of destruction with irregular margins.
- Loss of continuity of lamina dura, seen in more than one tooth.
HISTOLOGIC FEATURES:
- Dense infiltration of marrow by polymorphonuclear leukocytes.
- Bone trabeculae in involved site (sequestrum) are devoid of cells in the lacunae.
- separation of considerable portions of devitalized bone.
Acute Subperiosteal Osteomyelitis
CLINICAL FEATURES
- Pain , febrile condition , i/o and e/o swelling , parasthesia
- Bone involvement limited to localized areas of cortex.
- Pus ruptures rapidly through the overlying cortex, tracks along the surface of mandible under the periosteal sheath.
- Elevation of periosteum from cortex is followed eventually by minute cortical sequestration.
Infective osteomyelitis
- Tuberculous osteomyelitis
- Syphilitic osteomyelitis
- Actinomycotic osteomyelitis
Tuberculous osteomyelitis
- Non healing sinus tract formation
- Age group affected is around 15 – 40 years.
- Commonly seen in phalanges and dorsal and lumbar vertebrae.
- Usually occurs secondary to tuberculosis of lungs.
- Cases have been reported where mandibular lesions were not associated with pulmonary disease.
- Another common entrance is through a carious tooth via open pulp.
- Usually affects long bones and rare in jaws.
- Results when blood borne bacilli lodge in cancellous bone. Usually in ramus , body of mandible. may mimic parotid swelling or submassetric abscess.
Syphilitic osteomyelitis
- Difficult to distinguish syphilitic osteomyelitis of the jaws from pyogenic osteomyelitis on clinical & radiographic examination.
- Main features are progressive course & failure to improve with usual treatment for pyogenic osteomyelitis.
- Massive sequestration may occur resulting in pathologic fracture.
- If unchecked, eventually causes perforation of the cortex.
Actinomycotic Osteomyelitis
- The organisms thrive in the oral cavity, especially tissues adjacent to mandible.
- May enter the bone through a fresh wound, carious tooth or a periodontal pocket at the gingival margin of erupting tooth.
- Soft or firm tissue masses on skin, which have purplish, dark red, oily areas with occasional zones of fluctuation.
- Spontaneous drainage of serous fluid containing granular material.
- Regional lymph nodes occasionally enlarged.
- Mimics parotitis / parotid tumors