Odontogenic osteomyelitis of the jaw
Odontogenic osteomyelitis of the jaw is the most common purulent inflammatory disease of the maxillofacial area. Odontogenic osteomyelitis in its course is divided into acute, subacute and chronic forms, and by localization to osteomyelitis upper jaw and osteomyelitis of the lower jaw. The inflammatory process extends to the adjacent mediastinal spaces, as well as to the thickness of the bone, which leads to necrosis of the latter. . The cause of this purulent - necrotic process of the bone tissue of the jaw is exacerbation of the acute, as well as chronic periodontitis .
The size of the affected area is limited to a limited (3 to 4 teeth), diffuse (half / whole jaw), and focal odontogenic osteomyelitis.
The clinical picture of odontogenic osteomyelitis of the jaw depends on the state of the body's immune defense, the virulence of the microorganisms causing the disease, the age of the patient, the phase of the disease and the localization of the lesion.
Patients with acute odontogenic osteomyelitis complain of pain in the area of the causative tooth, which are soon joined by the signs of inflammatory periodontal lesions near the standing teeth. Painful sensations intensify, giving in the ear, temple and orbit.
Osteomyelitis of the lower jaw is characterized by a violation of the surface sensitivity of the skin of the chin with the groaning of the lesion, the mucous membrane. the vestibule of the mouth and the red border of the lower lip. With the development of a purulent inflammatory process in the peri-mandibular soft tissues, pain sensations move beyond the jaw, resulting in complaints that are characteristic of osteophlegmones: pain in chewing and swallowing, jaw-dropping, swelling. , изо рта исходит очень зловонный запах. The general body temperature rises, weakness appears, frequent headaches occur, a very fetid smell emanates from the mouth. The causative tooth becomes mobile, the adjacent teeth are also loosened, percussion is painful. Involved in a purulent inflammatory process, the mucous membrane of the transitional fold and gingiva is hyperemic and swollen, their palpation is sharply painful.
Under the periosteum of the body of the jaw and the alveolar process, pus accumulates. From under the edge of the gum, after the loosening of the teeth, there is a purulent discharge. In some cases, subgingival abscesses are formed. If the pus penetrates the cell space, phlegmon and abscesses of the maxillary tissues develop, which according to statistical data are present in about 60% of patients with osteotonic osteomyelitis of the jaws. In such patients, there is hyperemia of the skin and infiltration of soft tissues.
With the transition of odotogenic osteomyelitis of the jaw to the chronic phase, there is a significant decrease in pain and a decrease in the infiltration of soft tissues. In places of incisions of the mucous membrane of the oral cavity or skin, fistulas with prominent pus appear. In the area of finding a pathological focus, the teeth are mobile, and the jaw is flattened
In the acute phase, the treatment of osteotomous osteomyelitis of the jaws is aimed at eliminating a purulent inflammatory focus in the bone and nearby soft tissues. In addition, measures are taken to correct the disturbed functions of the body caused by the underlying disease. Surgical treatment consists in draining an infectious focus located in the bone by removing the tooth that is the source of the infection; at peraxhelial phlegmon and abscesses soft tissue is dissected with dialysis of the wound. In addition to surgical treatment, a purposeful balanced complex anti-inflammatory drug therapy is conducted.