📖 Oral Pathology
Infective osteomyelitis
Oral PathologyInfective 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
Non-odontogenic cysts
Oral PathologyNasopalatine cyst
Radiology
The nasopalatine cyst appears as a well-defined, round radiolucency in the midline of the anterior maxilla . Sometimes it appears to be 'heart-shaped' because of super-imposition of the anterior nasal spine.
Radiological assessment should include examination of the lamina dura of the central incisors (to exclude a radicular cyst) and assessment of size (the nasopalatine foramen may reach a width of as much as 10 mm).
Pathology
The cyst is lined by a layer of pseudostratified ciliated columnar epithelium and/or stratified squamous epithelium. The capsule of the cyst is fibrous and may include the incisive canal neurovascular bundle.
Nasolabial cyst
Radiology
'Bowing' inwards of the anterolateral margin of the nasal cavity has been recorded
Pathology
The nasolabial cyst is lined by non-ciliated pseudostratified columnar epithelium, which is often rich in mucous cells.
Infantile Osteomyelitis
Oral PathologyInfantile Osteomyelitis
- Osteomyelitis Maxillaries Neonatarum, Maxillitis of infancy
- Osteomyelitis in the jaws of new born infants occurs almost exclusively in maxilla.
Etiology
- Trauma – through break in mucosa cause during delivery.
- Infection of maxillary sinus
- Paunz & Ramon et al believe that disease caused through infection from the nose.
- Hematogenous spread through streptococci & pneumococci
Clinical features
- Fever, anorexia & intestinal disturbances.
- swelling or redness below the inner canthus of the eye in lacrimal region.
- Followed by marked edema of the eyelids on the affected side.
- Next, alveolus & palate in region of first deciduous molar become swollen.
- Pus discharge from affected sites
D/D for Infantile Osteomyelitis
- Dacrocystitis neonatarum
- Orbital cellulitis
- Ophthalmia neonatarum
- Infantile cortical hyperostosis
TREATMENT
- Intravenous antibiotics, preferably penicillin.
- Culture & sensitivity testing
- Incision & drainage of fluctuant areas
- Sequestrectomy
- Supportive therapy
Osteoradionecrosis
Oral PathologyOsteoradionecrosis
Clinical features
A reduction in vascularity, secondary to endarteritis obliterans, and damage to osteocytes as a consequence of ionising
Radiotherapy can result in radiation-associated osteomyelitis or Osteoradionecrosis. The mandible is much more commonly affected than the maxilla, because it is less vascular. Pain may be severe and there may be pyrexia. The overlying oral mucosa often appears pale because of radiation damage. Osteoradionecrosis in the jaws arises most often following radiotherapy for squamous cell carcinoma.
Scar tissue will also be present at the tumour site, often in close relation to the necrotic bone.
Radiology
Osteoradionecrosis appears as rarefying osteitis within which islands of opacity (sequestra) are seen. Pathological
fracture may be visible in the mandible.
Pathology
The affected bone shows features similar to those of chronic osteomyelitis. Grossly, the bone may be cavitated
And discoloured, with formation of sequestra.
Acute inflammatory infiltrate may be present on a background of chronic inflammation, characterized by formation
Of granulation tissue around the non-vital trabeculae.
Blood vessels show areas of endothelial denudation and obliteration of their lumina by fibrosis.
Small telangiectatic vessels lacking precapillary sphincters may be present.
Fibroblasts in the irradiated tissues lose the capacity to divide and often become binucleated and enlarged.
Management
Prevention of Osteoradionecrosis is vital. Patients who require radiotherapy for the management of head and
neck malignancy should ideally have teeth of doubtful prognosis extracted at least 6 weeks prior to treatment.
The dose of radiation,
The area of the mandible irradiated and
the surgical trauma involved in the dental extractions.
Surgical management of Osteoradionecrosis is similar to osteomyelitis.